The Geriatrics “Profanisaurus.” Volume 2 –  The diagnostic myths that do not die

Dan Thomas is an ST5 based in the Mersey Deanery (HENW) and is the Clinical Quality Representative on the BGS Trainees Council. He tweets @dan26wales

In 2013 Professor David Oliver wrote a blog, the Geriatrics “Profanisaurus”, a list of words and phrases that should be banned, he encouraged other ‘BGS-ers to join in the fun and add their own “unutterables”.

My contribution to this list is some frequently encountered diagnoses that should be approached with scepticism.

‘Bilateral cellulitis’: If both legs are infected then the person should be unwell. Usually red legs are caused by a combination of underlying pathology; acute lipodermatosclerosis, venous hypertension, venous stasis dermatitis, lymphoedema or panniculits. The legs are hot and swollen but in the context of someone who is afebrile with minimal inflammatory response. The reason they are not responding to antibiotics is because they do not have an infection. Continue reading

Book review: The Geriatrician in Court

Dr Shane O’Hanlon is a consultant geriatrician and Honorary Secretary of the BGS. He holds a law degree and has a special interest in medicolegal matters. He tweets @drohanlon

Most doctors spend their career hoping never to see the inside of a courtroom! While geriatricians are probably among the most rarely sued specialists, we can still have quite frequent involvement with the law – the Coroner’s Court is a good example. There is also an increasing amount of medicolegal work related to dementia, deprivation of liberty safeguards and mental capacity. In this environment there has been a gap in the market for a book that focuses specifically on our needs, but retired geriatrician Dr Geoffrey Phillips is at hand with help.

The Geriatrician in Court” is a handbook of “how to do it” based upon his thirty years of experience in preparing medico-legal reports and attending court to give expert evidence. The book covers all the main topics over the course of 226 pages. It begins with an outline of the legal system, criminal versus civil law, negligence and burden of proof. Important areas such as mental capacity, testamentary capacity, abuse, medical error and resuscitation all feature. Continue reading

Advanced Professionals supporting our frail patients, but how?

Beverley Marriott is an Advanced Nurse Practitioner working in the Birmingham community healthcare foundation trust. She is also a King’s College Older Person Fellow. She tweets @bevbighair

Nationally there is increasing recognition of the needs of frail older people in health systems, and  the UK’s rapidly ageing population will only increase in the years to come.

Dr Ram Byravan (Consultant and Clinical Director Heart of England Elderly Care) states that the prevalence of multimorbidity is on the rise, with 44% of people over 75 now living with more than one long-term condition –  geriatricians and GPs are uniquely suited to lead the response to the challenges of caring for this group. Continue reading

Is it time to redefine old age?

Vedamurthy Adhiyaman is a geriatrician working is North Wales. Here he discusses why we should redefine old age. He tweets @adhiyamanv 

Western literature arbitrarily defines old age as people above the age of 65 (Oxford textbook of geriatric medicine, Wikipedia etc). Few authors subdivide old age further as young old (65-74), old (75-84) and old-old (85+). This would make our reigning monarch ‘old-old’ and the next in line to the throne and our patron, old (not sure whether he would like to be called old…). And definitions of old age vary according to different parts of the world. For African countries, the United Nations set the age 60+ and the WHO defines 50+ as old. Dictionaries define old age as a later part of normal life without defining any numbers. Continue reading

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