‘How low to go?’ Top transatlantic research journals debate antihypertensive treatment in older people

The scientific journal of the British Geriatrics Society, Age and Ageing, and the Journal of the American Geriatrics Society have launched a joint initiative, publishing two articles debating the relative benefits and risks of treating hypertension in older people.

It is widely recognised that raised blood pressure is probably the single most important treatable risk factor for cardiovascular disease in later life. The evidence that older people can benefit from antihypertensive drugs has accumulated with a succession of randomised controlled trials over the past 35 years. These trials have shown reduced risk of stroke and myocardial infarction, as well as decreased total mortality. However, despite the extensive evidence that is now available, questions remain about who to treat and on optimal blood pressure targets. Consequently practice varies widely and many clinicians are uncertain about what best to recommend for their older patients. Continue reading

From uncertainty to understanding: Can psychodynamic theories improve our care of older adults?

Dr Juliette Brown is a locum consultant psychiatrist in CMHT for Older Adults in Newham and in liaison psychiatry at Newham University Hospital, and is a member of the Association for Psychoanalytic Psychotherapy in the NHS. 

Dr Cate Bailey is a Specialist Registrar in Psychiatry working in Liaison Psychiatry at Homerton University Hospital, and is a member of the Association for Psychoanalytic Psychotherapy in the NHS.

‘Psycho-analysis is not a child of speculation, but the outcome of experience; and for that reason, like every new product of science, is unfinished. It is open to anyone to convince himself by his own investigations of the correctness of the theses embodied in it, and to help in the further development of the study’ Sigmund Freud, On Psycho-analysis (1)

Can psychodynamic theory improve our care of older adults? A century of psychoanalytic thought and a half century of work by old age psychiatrists and psychotherapists suggest that it can (2-3). Psychodynamic approaches help in making sense of complex, bewildering and frustrating clinical encounters through the recognition and observation of unconscious communication (4). By becoming aware of the inner and outer worlds of ourselves and our patients we can provide more thoughtful and effective care. Continue reading

Book review: ‘Memory’s last Breath’ – a written exploration of life, love and personhood

Rachel Manners is a speciality doctor in hospital based complex continuing care in Edinburgh.  She is a particular interest in end of life care and in complex dementia care.  Her twitter handle is @RachelMannes1 (due to an unfortunate spelling incident that she cannot figure out how to fix!).

Journeying beyond questions of how and why disease happen; to considering what they truly mean in the lives of individuals is one of the great challenges of clinical practice. Dementia brings out this challenge particularly strongly given the questions it raises about not only what it means to think and remember, but what it means to be.  That is it to say, it forces the practitioner to consider what it truly means to be a person. For those of us who work with and for those who live with dementia (or experience it in our personal lives) these are important questions. My own practice in recent years has led me to wonder not only what I have to offer people with dementia, but also to begin to consider what they have to teach and offer me .

Thinking about these ideas, I came to the book  ‘Memory’s last breath:  field notes on my dementia’ to help me develop my understanding. This is the autoethnographic study of Gerda Saunders’ journey with and into dementia. 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

Old People’s Home for 4 Year Olds

Dr Zoe Wyrko is a Consultant physician at University Hospital Birmingham and is the Director of Workforce for the BGS. In this blog she discusses the recent Channel 4 programme in which she appeared, Old People’s Home for 4 Year Olds. She tweets @geri_baby

I’ve always had a soft spot for care homes. As a child I would occasionally go into work with my Mum and meet some of the old ladies she talked about. When I was older I started work in the same nursing home as a kitchen girl on Saturdays, and then later progressed to health care assistant. I remain proud of my training record from that time, showing I am competent to deliver personal care, clean dentures and cut nails.

This is why I was excited when an approach came from CPL productions, who were looking for geriatricians to be involved with a television programme they wanted to make about introducing children to a care home environment. 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

Shane O’Hanlon’s Age & Ageing Christmas Review- Part 2

Shane O’Hanlon is the Digital Media Editor for the BGS. He tweets @drohanlon

shaneThe second part of our look back at the most downloaded Age & Ageing articles of 2016…

  1. Jeanet Blom and team conducted a cluster randomised controlled trial of effectiveness and cost-effectiveness of a proactive, goal-oriented, integrated care model in general practice for older people in the Netherlands. No beneficial effects were found on QoL, patients’ functioning or healthcare use/costs, but GPs experienced better overview of the care and stability, e.g. less unexpected demands, in the care.

Continue reading

An overview of the Policy Forum for Wales event

Hospital in Bridgend, Wales. He is a care of the elderly physician with an interest in Parkinson’s Disease and movement disorders.
flag_of_wales_2-svgOrganised by the Policy Forum for Wales, this event which was held on 19 October, provided the Welsh Government, and other agencies, the opportunity to engage with key stakeholders and discuss public health policy issues that particularly affect Wales. This seminar was about involving health and social care senior policy makers in developing a vision for Wales and bringing together multiple organisations (public sector, voluntary and third sector) to have a dialogue about how best to influence the Welsh Government’s health and social care policies.

The day was kicked off by chair Mr Huw Irranca – Davies AM, with a cross party group on cancer introducing the theme of the day. This was followed by brief from Professor Siobhan McClelland on current trends in health care in Wales including a £700 million gap in the budget for health and social care (10% of the total health budget). She emphasised that service configurations should be decided according to local need rather than by committee or Government mandate. Continue reading

Emotionally shattering & frustratingly unsettling: “The Father” reviewed

The Father  - Claire Skinner, Kenneth Cranham - Photo credit Simon AnnandShane O’Hanlon is a consultant geriatrician in Reading, and Honorary Deputy Secretary & Digital Media Editor at the British Geriatrics Society. Here he reviews “The Father”, currently playing at the Wyndham Theatre in the West End.

Deliriogenic. Emotionally shattering. Frustratingly unsettling. These are some of the ways to describe French playwright Florian Zeller’s uncomfortable study of dementia, “The Father”.

For Andre (Kenneth Cranham), life has begun to lose its rhyme and reason. We enter at an uncomfortable moment, where his family are trying to explain why he needs a carer. He certainly seems to lack insight, but our impression of what he was like before his illness is never clear – an all too real feature of dementia where we never get to know the person behind the disease.

Continue reading

Book review: Geriatric Medicine At a Glance

glanceDr Shane O’Hanlon is a consultant geriatrician in Reading, and edits the BGS Blog; he tweets at @drohanlon

It seems like ages since the last quality textbook in geriatrics came out, so it is great to see this new addition to the popular “At A Glance” series. I’m a huge fan of these books, with their concise 2 page summary-style chapters that are ideal for quick reference. As a medical student they were perfect for revising, once you had read the main textbook: I spent many happy nights by candlelight with Pharm At a Glance, for example! Continue reading