Reflections of an Editor

David Stott is Professor of Geriatric Medicine at the Institute of Cardiovascular and Medical Sciences at the University of Glasgow and is Editor in Chief for Age and Ageing journal. He will be retiring as Editor in Chief of Age and Ageing at the end of 2018 and expressions of interest are invited from qualified candidates to succeed him in January 2019 after a period of handover. 

I am now coming toward the end of my 5 year tenure as Editor-in-Chief of Age and Ageing, having taken over this role from Roger Francis in February 2014.

Roger left the journal in terrific shape and so I was initially quite anxious about whether I would be able to ‘fill his boots’. However very quickly I realised that I was embedded in a fantastic team who are hugely supportive and great fun to work with.

The link between pain and frailty revealed: it’s time to move towards more effective pain management in older people

Dr. Marcos Saraiva is a geriatrician from the Division of Geriatrics of University of São Paulo Medical School, Brazil. He and his co-authors recently published the paper Persistent pain is a risk factor for frailty: a systematic review and meta-analysis from prospective longitudinal studies in Age and Ageing journal.

Pain is a very common condition in older people, ranging from 40% in community-dwelling older adults to 80% in institutionalised individuals. It is known that pain, especially persistent pain (defined as a painful experience that continues for a prolonged period of time that may or may not be associated with a recognisable disease process), is associated with depression, social isolation, anxiety, insomnia, falls, higher health costs, weight loss, greater vulnerability to stressors and functional loss in older people.

Managing Frailty and Delayed Transfers of Care in the Acute Setting: A call to get involved!

Debbie Hibbert  leads on the NHS Benchmarking Network’s community sector benchmarking projects, manages the Delayed Transfers of Care / Older People’s benchmarking projects, is the Project Manager for the National Audit of Intermediate Care (NAIC), and the National Audit of Care at the End of Life (NACEL). She tweets @Debbie_NHSBN 

In this blog, the Managing Frailty and Delayed Transfers of Care in the Acute Setting project is described. Clinicians are encouraged to get involved with this project, the outputs of which include a bespoke report for participants and access to an online benchmarking toolkit. To receive your log in details or for further information, please contact josh.davies@nhs.net.

Driving quality improvements in the care of older people remains a key issue for the NHS as the population of the UK ages. The NHS Benchmarking Network is back with another project following on from previous work on the care of older people, and delayed transfers of care.  The new project continues the Network’s six-year partnership with the BGS and will help our members to gather much needed data to inform service change and future strategic decisions.

10 days in a hospital bed leads to 10 years’ worth of lost muscle mass in people over age 80

Dan Thomas is an ST6 working in Liverpool. He is the BGS Clinical Quality Group Trainee Rep and the Deputy Media Editor. He tweets @dan26wales

‘10 days in a hospital bed leads to 10 years’ worth of lost muscle mass in people over age 80’

I have lost count of the number of times I have quoted this fact, I use it when teaching on frailty, and I have used it when assessing people in the emergency department to explain the risks of hospital induced deconditioning. I regularly hear other Geriatricians use this fact. It is emblazoned across much of the #EndPJParalysis material, and is quoted (unreferenced) on the NHS improvement website.

Yoga-based exercise can improve well-being for older people

This blog was first published on the National Institute for Health Research (NIHR) Dissemination Centre Discover Portal. Read the corresponding Age and Ageing paper Yoga-based exercise improves health-related quality of life and mental well-being in older people: a systematic review of randomised controlled trials.

Yoga-based exercise offers a safe and accessible way to improve health-related quality of life and mental well-being for people over 60. Evidence for a moderate benefit of yoga in later life now extends beyond improved balance and flexibility.

Yoga includes stretches, poses, breathing routines and meditation. This review focused on the physical exercise/activity components. Most of the 12 included trials took place in Western countries and classes were all run by qualified yoga instructors as in the UK. Class attendance was high for eight weeks or more (50 to 96%). However, women outnumbered men by three to one, implying that yoga classes may need adapting to appeal to older men.

Yoga classes are widely available and could offer an accessible way to improve older people’s activity levels and well-being. The research was moderate to high quality, but it cannot yet show exactly how much yoga or which kind works best for particular groups of people. However, the good news is that these approaches seem effective.

Forging international links, sharing ideas and developing friendships to build research collaborations

Dr Jenni Burton (@JenniKBurton) from the University of Edinburgh and Dr Patrick Wachholz (@Patrick23711608) from Sao Paulo State University joined 12 researchers from across the UK and 17 from across Brazil to participate in a Newton Fund researcher links workshop: ‘Identifying and addressing shared challenges in conducting health and social care research for older people’, held between the 11^th-15^th of June in Botucatu, Brazil. The workshop was funded by the British Council and the Sao Paulo State Research Foundation (FAPESP) and organised by the University of Nottingham and UNESP.

Over the course of five days we worked together under the supervision of our Brazilian and UK mentors (Prof Alessandro Ferrari Jacinto, Prof Paulo Villas Boas, Prof Vanessa Citero, Dr Adam Gordon, Prof Tom Dening & Dr Jay Banerjee) to share ideas, learn from each other and work on developing new collaborative research projects.

To set the scene, Brazil is the largest country in South America with an estimated population of 16 million adults aged 65 and over. Sao Paulo State has a population of 41 million people and is the most economically and research active state in Brazil with 34% of the GDP. Amazing stat of the week was that for every four research papers published in Latin America, two will be authored in Sao Paulo State!

July 2018 issue of Age and Ageing journal is out now

The July 2018 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 in this issue include:

• Blood pressure targets in treatment of hypertension
• Falls prevention
• Probiotics and prevention of infection
• Improving healthcare outcomes in care homes
• Caregiver relationships and Parkinson’s disease

The Editor’s View article gives an overview of the issue with a summary of highlights. This article is free to read and can be viewed here.

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.

Autumn Speakers Series: The boundary between health and social care

Adam Gordon is Clinical Associate Professor in Medicine of Older People at the University of Nottingham.  He is currently principal investigator for the Dunhill Medical Trust funded PEACH study which considers using quality improvement collaboratives to implement Comprehensive Geriatric Assessment in care homes.  His twitter handle is @adamgordon1978.  You can follow the PEACH study @PEACHstudy. He will be speaking at the upcoming BGS Autumn Meeting in London.

Care home residents in the UK receive their healthcare predominantly through the National Health Service. Their social care – primarily focussing on enablement to support activities of daily living and supporting participation in society – is provided by staff in their care home.

Or at least that’s how it looks on paper.  In reality, the boundary between health and social care is less well defined.  Providing care to the older people who live in care homes, many of whom have multiple conditions and are approaching the end of their life, requires frequent give and take between healthcare and care home staff.

Older people are not only living longer: positive results in the temporal trends of physical functioning

Giola Santoni is a researcher on health status and health trends in older people. She has worked at the Aging Research Center, Karolinska Institutet in Sweden and she is currently a biostatistician at the same institute.

Anna-Karin Welmer is associate professor and senior university lecturer at Karolinska Institutet. She is vice-principal investigator of the Swedish National study on Aging and Care in Kungsholmen (SNAC-K) population-study. Anna-Karin’s primary area of research interest is the epidemiology of physical function, disability and falls in older persons.

Despite the rapid gain in life expectancy in the last century, it is not clear if the added years consist of healthy years or years lived in poor health and disability.

Previous studies have reported stable or even declining levels of disability. However, disability is defined as the inability to perform basic activities of daily living independently in the environment a person lives. Disability trends can therefore be influenced by changes in the environment such as development of technical equipment. To what extent does the encouraging trend towards declines in disability in the older population reflect actual improvements in physical function?