Autumn Speakers Series: “Interface medicine”

Eva Kalmus has been working as Interface Medicine GP at Epsom and St Helier NHS Trust since February 2015 and previously looked after inpatient beds at New Epsom and Ewell Community Hospital. She was also a community ward GP in Wandsworth and virtual ward lead in Epsom. Currently her work is focussed on discharging patients for whom the acute hospital no longer offers net benefit as quickly and efficiently as possible and improving communication, aiming for primary, community and social services to pick up where secondary care stops. She will be speaking at the upcoming BGS Autumn Meeting in London.

“Interface medicine” has a number of definitions in different contexts—it seemed an appropriate title to describe primary care-trained doctors working in community or hospital settings whose aim is to maximise quality of life for older frail patients using skills and knowledge from both general practice and geriatric medicine.

On one side are Interface Medicine GPs now titled GeriGPs within BGS; on the other are Community Geriatricians but there is significant overlap in what we do. Working together we can best support our patients—and it is a very satisfying extension to our core business.

How should healthcare services to care homes be configured – results from the Optimal Study

Adam Gordon is Clinical Associate Professor in Medicine of Older People at the University of Nottingham. He tweets @adamgordon1978 Claire Goodman is Professor of Health Care Research at the University of Hertfordshire.  She tweets @HDEMCOP Here they describe findings from the Optimal Study, funded by the National Institute of Health Research and delivered by a collaboration of researchers from the Universities of Hertfordshire, Nottingham, Surrey, City University London, University College London, Kings College London and Brunel University.

The UK care home sector, with 425,000 beds, is just over three times the size of the acute hospital sector.  It is home to some of the oldest and most vulnerable members of UK society.  The average resident is over 85, has multiple health conditions, cognitive impairment and physical dependency.  Providing care to such older adults is recognised to be complex and challenging.

Loneliness; A public health epidemic

Helen Stokes-Lampard is Chair of the Royal College of General Practitioners (RCGP), the UK’s largest Medical Royal College, representing over 52,000 family doctors across the UK. She is a part-time GP partner at The Westgate Practice in Lichfield, Staffordshire, and was the Head of Primary Care Teaching (undergraduate) in the Medical School of the University of Birmingham until becoming RCGP Chair. She will be speaking at the Loneliness in Older People and its Impact on Health event on 13 June at Wellcome Collection in London.

As a GP in the Midlands, I see patients in my surgery day after day with a variety of different health needs. We GPs are privileged to be the cornerstone of our communities, and the vast majority – over 85% of people – come to see their GP at least once a year.

Last year, at my speech to RCGP Annual Conference, I introduced the world to my patient, Enid, a character who every GP will recognise from their own surgery and their own community. My inspiration for this character stems from the type of patient which every GP will be aware of: she’s 84, she has hypertension and type 2 diabetes, and has intermittent flares of osteoarthritis pain in both her hips. Most significantly, she recently lost Brian, her husband of 62 years.

Using population sub-segmentation to promote tailored end of life care in later life

Professor Martin Vernon is National Clinical Director for Older People and Person Centred Integrated Care at NHS England. He tweets @runnermandoc. Dr Dawn Moody is Associate National Clinical Director for Older People and Integrated Person-Centred Care for NHS England. She tweets @Moody_D_K. They will be speaking at the BGS Living and Dying Well with Frailty event today. Follow the conference via #bgsconf

Frailty is an especially problematic long term condition characterised by declining intrinsic capacity to deal with stressor events such as acute illness or physical accidents. When severe it significantly increases personal annual risk of reaching end of life. While occurring alongside human ageing, not everyone develops frailty and it is not solely confined to older people. NHS England estimates 20% of the population aged 90 and over remains fit and are therefore likely to be fortunate in ageing well. Conversely we estimate that up to 25% of people aged 65 to 69 are living with mild frailty in England which compared to their fit peer group places them at twice the annual risk of reaching end of life.  A further 5% of this age group is estimated to be living with moderate or severe frailty.

Geriatric conditions, are they recognized as relevant problems by community dwelling older people?

Marjon van Rijn is a PhD candidate at the department of Geriatric Medicine in the Academic Medical Center in Amsterdam and lecturer at the School of Nursing, Faculty of Health, Amsterdam University of Applied Sciences the Netherlands. In this blog she comments on her recent paper in Age and Ageing.

Comprehensive Geriatric Assessment (CGA) is increasingly implemented in community care settings and involves an assessment of physical, psychological, functional and social geriatric conditions, such as urinary incontinence, memory problems, fall risk and loneliness.

In this study, CGA is part of a complex intervention to prevent disability in community dwelling older people. Older people with an increased risk of functional decline, according to the Identification of Seniors at Risk questionnaire that was validated for primary care, were invited for a CGA at home. A community care registered nurse visited older persons to conduct the CGA, and if necessary, made an individual care plan with several follow up visits.

Comprehensive Geriatric Assessment in Primary Care

Lynn Lansbury is NIHR CLAHRC Principal Investigator in Academic Geriatric Medicine at the University of Southampton. Here she talks about CGA in Primary Care, which she shares on Twitter @CGA_GP

Adam Gordon’s blog introduced a timely study. With an ageing population it is important that we develop services that are fit for the changing demographic. There is convincing evidence that Comprehensive Geriatric Assessment (CGA) has a place in best practice for the care of older people. The evidence base is particularly strong in acute settings and studies have also been carried out in people’s homes. The Proactive Healthcare for Older People in Care Home (PEACH) study explores CGA in care homes Thus there is interest in identifying the place of CGA in other settings. Our new study, Comprehensive Geriatric Assessment in Primary Care (CGA-GP): The Fit for Later Life Project funded by NIHR CLAHRC Wessex, investigates the GP surgery as a setting.

Geriatric medicine in New Zealand: the patients

In the first part of this two-part blog, Vicky Henstridge looks at the patients she’s cared for since moving from the UK to New Zealand.

Today marks exactly one year since we arrived in our new home town, and I am in a reflective mood. There are many differences between medicine in the UK and New Zealand, but those between primary care and geriatrics in the two are perhaps most striking. The semi-private nature of General Practice is something that on the surface seems abhorrent, as we Poms still hold dear to the ideals of a healthcare system free at the point of use.

Curiouser and curiouser: the changing numbers in dementia diagnosis

Tom Dening is Professor of Dementia Research at the Institute of Mental Health at the University of Nottingham. He tweets at @TomDening

Dementia is getting more common as the population of the UK and, for that matter, the world gets older. But just how common? How many people are out there? It’s a really important question for us all.

There have been some interesting developments over the last year. Until then, the official figure was 800,000 in the UK. This was based on projections from the MRC Cognitive Functioning and Ageing Study (CFAS), data that were collected during the 1990s, and updated based on the demographic profile of the elderly population since then. So this figure was based on numbers around 20 years old.

Therefore it was important to replicate the study and eventually CFAS II was funded and carried out. The team reported their findings in the Lancet last year.

The NHS England Five Year Forward View: A crucial document for our speciality, for the care of older people and for Health and Care Services in England.

David Oliver is President of the BGS, Visiting Fellow at the King’s Fund and Consultant Geriatrician at the Royal Berkshire Hospital, Reading. In part 1 of a 2-part blog, he discusses how the NHS “Five Year Forward View” is important for people involved in the care of older people.

October 23^rd 2014 is memorable to me, as it’s my 23^rd wedding anniversary. It’s also now of significance to the rest of us, as the date that NHS England’s “Five Year Forward View” plan was published. I realise not many of you will have had the time or necessarily inclination to read it, though at only 39 pages it’s an easy canter.

I also know it hasn’t attracted much Twitter activity from fellow BGS members. But it’s a document which I suspect will have far reaching influence and implications for the services we all work in. These implications seem largely positive. Let me explain why.

The toxic cocktail that leads to patient complaints – how can the NHS line its stomach?

Dr Claire Dow is Consultant Physician at Barts Health NHS Trust. She tweets at @ClaireDow1

Think not of what you can do for your complainants, but what your complainants can do for you. (Apologies to President Kennedy.)

At the recent BGS/RCP conference on Acute Care of Older People, we were privileged to hear Dame Julie Mellor talk about patient complaints from her perspective as Parliamentary and Health Service Ombudsman.

For an audience composed mainly of Geriatricians and Acute Physicians, it came as no surprise that she felt that hospitals are poorly equipped to deal with the older people who have multiple conditions.