Developing new guidance on how to measure lying and standing blood pressure- harder than you think!

Shelagh O’Riordan is a consultant geriatrician and the clinical lead for the National Audit of Inpatient  Falls. She was an acute hospital geriatrician in Canterbury in Kent for 14 years but moved in September 2016 to work Kent Community Foundation Trust as a community geriatrician. She developed and runs East Kent Falls and Osteoporosis service. She tweets at @jupiterhouse1  

bpAs the clinical lead for the National Audit of Inpatient Falls (NAIF) I have been involved in the development of some new tools to standardise fall prevention in hospitals and they are being launched this month. The first of these was launched on 13/01/17 and is on the measurement of lying and standing blood pressure.

One of the results we found in the last audit round (data collected May 2015) was that on average only 16% of patients over 65y in an acute hospital after 48 hours had had a lying and standing BP recorded! I found this to be a fairly shockingly low number. I’m known, like many geriatricians, to be a bit obsessed with measuring lying and standing BP. Continue reading

Multi-morbidity – the case for change

David Paynton is a GP in an inner city surgery. He is also the Clinical Lead for Commissioning for the RCGP.

Dr David Paynton

Generalists are the solution.

For too long policy makers have ignored what clinicians on the front line have been telling them, people with multiple conditions not only exist but are the mainstream.

It is our failure to recognise this fact that has put pressure in the system as the NHS struggles to keep its head above water especially when one adds social factors, depression and mental health into the mix of complexity.

The RCGP “responding to the needs of patient with multi-morbidity” has created a powerful case for change with the need to substitute ever-increasing investment into super specialism by a call for the generalist to support those with multi-morbidity in the community. Continue reading

Planning for our new BGS website… Have your say!

survey-2Calling all BGS Members and friends! We are inviting you to complete this survey to help us find out more about what our members, and other visitors, are looking for from the new BGS website which will replace the current main BGS site.

This survey should take no longer than 5 – 10 minutes to complete, depending in the length of your answers. This survey also provides the opportunity to join the Website Consultation Group and/or volunteer to review and update existing materials from the current site. Continue reading

Joining up care for older people with frailty

Across the UK, innovative collaborations between GPs and specialist geriatricians are paving the way to better care for older people with frailty

rcgp-bgd-coverA new joint report from the Royal College of GPs and the British Geriatrics Society has been published today, showcasing how GPs and geriatricians are collaborating to design and lead innovative schemes to improve the provision of integrated care for older people with frailty.

Advancements in medicine are a great success story, and as a result our patients are living longer, but they are also increasingly living with multiple, long term conditions and that brings a number of challenges for general practice and the wider NHS.

Older patients make up the majority of those attending GP surgeries and acute hospitals so getting the right combinations of care in the right place and at the right time is crucial to avert avoidable admissions and delayed discharge from hospital. Continue reading

The steps we are taking to reduce inpatient falls

Prof Finbarr Martin is a Consultant Geriatrician at Guy’s and St Thomas’ NHS Foundation Trust and Professor of Medical Gerontology at King’s College London. He is a former President of the British Geriatrics Society.

patient-falls-preventionHow good is your department and hospital at preventing your patients falling? About 600 inpatients fall every day. As clinicians, we are fully aware of the injuries that can result from older people falling in hospital and the serious effect a fall can have on their recovery. So what can we do to prevent this happening? NICE guidance suggests we can reduce the number of falls by up to a third. The issue is high on the national patient safety agenda, but we need to be able to gather reliable data to ascertain if greater awareness is leading to the falls rate reducing.

Last year, the London Royal College of Physicians carried out an audit of hospital policies and practice in falls prevention, producing a national picture and a report on each hospital in England and Wales. The audit items were based on guidance from NICE and NPSA. You can access the national report here. Please find the time to take a look at your hospital’s data. Continue reading

Catching older people before they fall – a simple intervention to help identify those at risk

Simon Thomas is an Honorary Fellow of the School of Pharmacy, Keele University and a Director at Prescribing Decision Support – a Keele University spin-out company that delivers knowledge-based e-media systems designed to support healthcare decision making. Most recently, Simon has worked with NICE and Boehringer Ingelheim Ltd on the development of an innovative anticoagulation therapy decision support tool that assists patients and doctors in shared decision-making. Simon can be contacted at s.thomas@keele.ac.uk

ToolkitFalls and fall-related injuries in older people is a high-risk, high-cost problem. Notwithstanding the considerable human impact – distress, pain, injury, loss of confidence, loss of independence and mortality – falls account for the largest number of emergency hospital admissions for older people in the UK and cost the NHS over £2 billion each year. Continue reading

‘Help yourself’; Supporting older people towards independence

Rudi GJ Westendorp, is Professor of Medicine at Old Age at the Department of Public Health and Centre for Healthy Ageing, University of Copenhagen. In this blog he discusses his recent Age and Ageing paper New horizons: Reablement – supporting older people towards independence.

cottage

The majority of older people wish to remain independent and live in their own homes for as long as possible. Instead maintaining a cruising altitude however, the process of ageing forces many to descend towards dependency and long-term care.

It’s never too late to learn new ways for coping by yourself and to make preparations for independent living in older age. But it is a shame that too often these good intentions are superseded by doubts and avoidance. Continue reading

Book review – “Geriatric Medicine: An Evidence Based Approach”

9780199689644_450Philip Braude is an ST6 in Geriatric Medicine, specialising in perioperative medicine.

Geriatric Medicine: An Evidence Based Approach, edited by Frank Lally and Christine Roffe, is written by an eminent list of international experts condensing key and often difficult issues in modern geriatrics to chapters of a few pages. It aims to be a “clinical reference for health care professionals” but is certainly not a comprehensive geriatric medicine text.

Continue reading

The NHS England Five Year Forward View: part 2

DAVID OLIVERThis is the second of two blogs by BGS President David Oliver, focusing on the recent launch of the NHS England Five Year Forward View. Read part one here.

In my blog on 24th October, I described the crucial marker that this document has laid down for the mid-term future of English Health and Care services and the “big picture” implications. Here I want, in the words of the “Dragon’s Den” voice-over, to “drill down” into some of the key features and their implications for fellow BGS members.

Whilst we deal with the consequences of preventable ill health in older age, the report’s focus on prevention across the lifecourse is commendable. We know that there are major inequalities in life expectancy and healthy life expectancy at 65 and that around half of all poor health in older age is attributable to life style factors. So its good to see a clear challenge to government around diet, obesity, alcohol, cigarettes and exercise and the need to move away from “nudge” and “responsibility deals” to more proven preventative interventions.  We also welcome the greater focus on local government’s role in reducing social isolation or improving housing for older people. And on the untapped contribution that volunteers can make to helping older people remain connected and active – as well as the benefits  for older people who are volunteers. Continue reading

November issue of Age and Ageing journal out now

The November 2014 issue of Age and Ageing, the journal of the British Geriatrics Society is out now.

A full table of contents is available here, with editorials, research papers, reviews, short reports, case reports book reviews and more. Hot topics this issue include:

  • Guidelines for management of frailty
  • Systematic review on sarcopaenia
  • Inappropriate drug use in older people
  • Co-morbidities in dementia
  • Cost-effectiveness of telecare

The Editor’s View can be read here.

This issue’s free access papers are: