Why I’m Fine with “Frailty”

Professor David Oliver is a Past President of the BGS, clinical vice-president of the Royal College of Physicians, and a consultant in geriatrics and acute general medicine at the Royal Berkshire NHS Foundation Trust. Here he responds to Steve Parry’s recent BGS blog, The Frailty Industry: Too Much Too Soon? He tweets @mancunianmedic

Dr Steve Parry’s recent blog here, “The Frailty Industry. Too much too soon” certainly generated a great deal of hits and online responses. He is a well-respected geriatrician, has done sterling work for our speciality and we are friends in a speciality where solidarity and mutual respect are wonderfully the norm.

The more I reflect, the more I realise that none involved in the debate are a million miles apart in any case. We have all devoted our professional lives to the skilled multidisciplinary care of older people, especially those with the most complex needs; to the speciality of geriatric medicine; to the leadership of local services; to the education of the next generation of geriatricians and to developing the evidence base for practice.  Continue reading

If frailty is viewed by some as a “commissioning Trojan Horse” this should be admitted

Dr Shibley Rahman is currently an academic physician in dementia and frailty. His contribution on the diagnosis of behavioural frontal frontotemporal dementia, published while he was a M.B./Ph.D. student at Cambridge in 1999, is considered widely to be an important contribution to the field, even cited in the Oxford Textbook of Medicine. Here he responds to Steve Parry’s recent BGS blog, The Frailty Industry: Too Much Too Soon?  He tweets at @dr_shibley.

In response to Steve Parry’s recent BGS blog, The Frailty Industry: Too Much Too Soon?, I would simply in this article like to set out some of the strengths and weaknesses in the conceptualisation of frailty, with some pointers about “where now?

There is, actually, no international consensus definition of frailty (although there is one of a related term “cognitive frailty”).

In a world of fierce competition for commissioning, and equally intense political lobbying in health and social care, the danger is that a poorly formulated notion becomes merely a “Trojan Horse” for commissioning.

I must humbly depart from the views of some colleagues – for me, frailty is not just a word. I could likewise point to other single words which cause gross offence, which are unrepeatable in my blogpost here. Continue reading

Can Geriatric Medicine be learnt through reading ‘George’s Marvellous Medicine’?

Dr Amy Heskett is a Speciality Doctor working in a Community Geriatrics team within West Kent called the Home Treatment Service. This team works alongside paramedics, GPs and district nurses to prevent unnecessary hospital admissions for people with frailty, multiple comorbidities, caring responsibilities or as part of end of life care.  The home visits use bedside testing and a multi-disciplinary approach to provide management of many acute medical presentations in a home-setting.  The development of these holistic plans requires a creative approach and the experiences often generate tweets @mrsapea and blogs at communitydoctoramy.wordpress.com

I read Roald Dahl’s ‘George’s Marvelous Medicine’ to my children today and my son said, “You really love the Grandma in this don’t you Mum?”

It’s true!  It was one of my favourite books during my own childhood and I now spend a large amount of time perfecting the Grandma’s voice for my children and absorbing the story with them as they snuggle on the sofa.  There is personal meaning to some of the pictures too and so a picture of George stirring the giant saucepan is hung on our kitchen wall.  The text describes ‘A rich blue smoke, the colour of peacocks’, at which point we cheer because Peacock is our family name. Continue reading

Framing the narrative of frailty differently will help to promote wellbeing

Dr Shibley Rahman is currently an academic physician in dementia and frailty. His contribution on the diagnosis of behavioural frontal frontotemporal dementia, published while he was a M.B./Ph.D. student at Cambridge in 1999, is considered widely to be an important contribution to the field even cited in the Oxford Textbook of Medicine. He has a passionate interest in rights-based approaches which he accrued as part of his postgraduate legal training. He tweets at @dr_shibley.

It’s great that frailty as a ‘brand’ is getting so much publicity, but is it all the right kind of publicity? For example, “Our treatment of the frail elderly is a national scandal”, Sunday Express, 8 March 2011. (cited in Manthorpe and Iliffe, 2015)

But some of the copy has been to generate a “moral panic”, defined as a feeling of fear spread among a large number of people that some evil threatens the well-being of society. Continue reading

Some things in life are free!

Cliff Kilgore is a Consultant Nurse for Intermediate Care and Older People within Dorset Healthcare NHS Trust and he is also a Visiting Fellow to Bournemouth University. He is Chair of the BGS Nurses and Allied Healthcare Professionals Council. He also is a member of the BGS Clinical Quality Steering Group. He tweets @kilgore_cliff

Many of our readers will know that the BGS has been at the forefront of promoting older people’s healthcare and wellbeing for many years. In fact, we celebrated 70 years of this in March. Leading the way for older people has enabled the BGS to have great influence on many aspects of policy and guidance including Fit for Frailty, The Silver Book, Comprehensive Geriatric Assessment (CGA), as well as ever increasing influence on training and development of all clinicians. The BGS has long recognised the importance of developing trainees and to support this has offered many benefits to its members including free membership for medical students and foundation doctors, study grants and sponsorship and support of research projects. Continue reading

Dementia awareness is not just for one week – it’s for life

Dr Shibley Rahman is currently an academic physician in dementia and frailty. His contribution on the diagnosis of behavioural frontal frontotemporal dementia, published while he was a M.B./Ph.D. student at Cambridge in 1999, is considered widely to be an important contribution to the field even cited in the Oxford Textbook of Medicine. He has published widely on dementia, and his first book ‘Living well with dementia’ won best book for health and social care for the BMJ Awards in 2015. His third book ‘Enhancing health and wellbeing in dementia: a person-centred integrated care approach’ was published earlier this year on aspects of the integrated care pathway, and likewise has been critically acclaimed. He, furthermore, has a passionate interest in rights-based approaches which he accrued as part of his postgraduate legal training. He tweets at @dr_shibley.

This week – in England –  it’s ‘Dementia Awareness Week’ – 14-20 May 2017. But so what?

The problem is – ‘dementia awareness’ means different things to different people. In a nutshell, I hope that the workforce can embrace the notion that people living with dementia are incredibly rewarding to support and look after, and use this week as part of a celebration of this.

If you’re working in health and social care, it can be surprisingly easy to overestimate the knowledge about dementia amongst some members of the general public. Continue reading

Kindness: The essential skill in supporting a dignified death

Sue Newsome supported her Father during the last year of his life. In this blog she shares her thoughts and feelings from a carer’s perspective.  

My Dad had suffered for a year after his stroke, his gradual deterioration was devastating for him. As his physical and cognitive ability deteriorated he became more frustrated at his dwindling independence. Dad told me he wanted to die many times in different ways throughout the last year of his life. He told me he just wanted “to lay down and die” and that he felt like he was ‘drowning’, as an illustration of his depression. Numerous times he told me he wanted to be with my Mum, who had died 15 years ago. Ironically, whilst I loved and cared for Dad and never wanted to lose him, at times I wanted him to get his wish and die. Continue reading

“Constant bleeps, all of the time…”: Time to debunk the med reg ‘superhero’ myth?

James Fisher is a consultant geriatrician at Northumbria Healthcare NHS Foundation Trust. He tweets at @drjimbofish and in this blog article discusses a recent publication looking at the role of the medical registrar from the perspective of junior doctors interested in geriatric medicine.

Being the medical registrar, or ‘med reg’, is recognised as being a tough job. The med reg is often considered to be the ‘go to’ person for the hospital at night – to shamelessly rip off a well-known 1980s TV show, “If you have a problem… if no one else can help… and if you can find them… maybe you should bleep… the med reg”.

The medical registrar is the senior training grade in medical training; effectively it’s the last stop on the road to becoming a consultant physician. Continue reading

Back to the Future? Please, no more studies “in the elderly”!

Shane O’Hanlon is a geriatrician and digital media editor for the British Geriatrics Society. He tweets @drohanlon Zoe Wyrko is a geriatrician and workforce lead for the British Geriatrics Society. She tweets @geri_baby

Sometime back in the 80s, when we were both nippers, Marty McFly got the chance to travel 30 years into the future and see how the world would change. Around this time in the medical literature it became common to take an interesting concept and tag “in the elderly” onto the end of it. Back then, we had articles on burns, epilepsy, even blunt chest trauma “in the elderly”. It was generally accepted that once you hit 65, *everything* changed. Suddenly you would be most unlikely to have surgery, palliation became the default, and you were fairly much on your way out. Because, after all, while nobody would ever dream of grouping neonates up to 40 year olds (the age we have just reached) into one group, surely it is acceptable to assume everyone from 65-105 is identical? Continue reading

Sit up, Get Dressed, Keep Moving: Deconditioning Syndrome Awareness and Prevention Campaign: why is everyone talking about it?

Dr Amit Arora is a consultant geriatrician at the University Hospital of North Midlands and has served as Chairman of England Council of the British Geriatrics Society. He and his team have developed the campaign “Sit up, Get Dressed, Keep Moving” which is being adopted in many NHS hospitals and abroad.

In David Mitchell’s recent article “‘Get Out of Bed!’ scheme is more symptom than solution for the NHSwhich was published on the Guardian website he appreciates the simplicity and value of the campaign but questions whether the campaign is financially motivated.

I congratulate and thank Mitchell for raising awareness about benefits of early functional normalisation: “The Principle that people who have been hospitalized should re-start normal life as soon as they can is already well established”. He further writes that “it’s suspicious that a campaign exclusively pushing the idea of getting up and going home should coincide so precisely with the NHS’s dire shortage of money.”  I would like to detail how the campaign started and how it is free from any ‘spin’. Continue reading