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. Continue reading

“The Emperor’s New Clothes”

Professor Martin Green OBE has had an extensive career in NGO development, both in the UK and internationally, and is Chief Executive of Care England, the largest representative body for independent social care services in the UK. He will be speaking at Living and Dying Well with Frailty event on 6 March. Follow the conference on the day via #bgsconf

We have now got a Department of Health and Social Care, what a difference that is going to make (I said sarcastically). With increasing regularity, the Government seems to think that messing about with the headed paper is a route to change. How much evidence do they need that changing titles and rejigging the logos is not going to deliver the transformational change that is required in order to deliver the route map to integrated services. If we had spent one tenth of the money we have spent on new titles, new structures and new logos on culture change, we would be in a far better position than we find ourselves today and the integrated services that citizens are crying out for might be a more attainable goal. Continue reading

The Other “F” Word: Is upstream prevention the way forward for falls?

Steve Parry works in acute medicine and older people’s medicine. He has a special interest in investigation and treatment of falls and blackouts in adult patients of all ages. He is BGS Vice President – Academic and Research.

Since those heady days in the late 90s when our local falls service was started by Rose Anne Kenny, falls services have moved from novelty to mainstream in the UK’s care of older people landscape. But has this service ubiquity made a difference?

Probably. Possibly. Or perhaps not. It’s almost impossible to say. Falls are notoriously poorly recorded and coded, though falls surrogates like hip fracture, the tip of the falls iceberg, provide at least a hard outcome measure universally recorded. Here, however, despite a decade and a half of falls and bone health services, the news is not good. Continue reading

March 2018 issue of Age and Ageing journal is out now

The March 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, expert reviews, short reports, case reports and more.  

Hot topics in this issue include:

  • Increasing medication use in older people
  • Frailty and mortality
  • Excessive alcohol intake in later life
  • Z-drugs, falls and fractures
  • Research methods for cohort studies

    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. Continue reading

    Fostering attachment in dementia care

    Matthew Berrisford is a Charge Nurse at The Meadows Community Hospital, Pennine Care NHS Foundation Trust. He tweets @berrisfjord

    One of the most useful pieces of advice I can share with a colleague working in dementia care is this: whenever confronted with what you perceive to be attention­-seeking behaviour, reframe it to yourself as attachment-seeking behaviour.

    Attachment is a hard-wired evolutionary mechanism in all mammals. Simply put, in order to survive, infants must imprint upon a main carer (typically one or both parents) to ensure that their essential needs are met.

    These needs are not purely physical (food, drink, protection); the relationship itself is essential. This fact is aptly demonstrated by animal experiments (Harlow’s monkeys and Skinner’s rats, for example) which consistently show that infant mammals raised in isolation – with no access to a main carer to imprint upon – age quickly and die younger. Continue reading

    A Warm Glow in Solihull

    Maxine Burrows and Yvonne Obaidy are Collaborative Leads for Early Help 0 – 19 at Solihull Metropolitan Council.  They develop high quality sustainable services for children, young people and families.  In this blog they talk about a new intergenerational pilot that they are working on and how they are enjoying the challenges and diversity that this work is providing.  Dr Zoe Wyrko (Consultant Geriatrician. Associate Medical Director – Quality Development, University Hospitals Birmingham) is providing them with support and help as needed, including evaluation tools for the older adults. You can follow them at @EngageSolihull

    We are carrying out a pilot of intergenerational working in Olton, a district of Solihull in the West Midlands, with two local partners – St Bernard’s Residential Care Home for older adults and Tender Years Day Nursery. The care home has lovely cosy rooms – which are not huge, and the nursery has transport for five children so we chose to do a small pilot involving just five older adults to start with. Our intergenerational activity takes place every Wednesday at 10.30am for one hour.

    We had several preliminary individual meetings with the nursery and the care home and then all parties came together for a final planning meeting two weeks before the pilot started. The meetings were useful for clarifying roles and responsibilities and planning some of the activities.  Most importantly the final meeting enabled the care home staff and nursery staff to meet and share their reasons for taking part in the pilot. Continue reading

    Spring Speakers Series: Are rules of thumb the answer?

    Nathan Davies is a Senior Research Fellow at University College London focusing on care for people with dementia towards the end of life and supporting family carers. In this post he talks about his upcoming talk at the BGS Spring Meeting in Nottingham on his work developing rules of thumb for providing care towards the end of life for someone with dementia.

    Can rules of thumb help manage uncertainty and the challenges facing practitioners caring for someone with dementia at the end of life?

    We know that caring for someone towards the end of life can be a rewarding and intimate experience with that individual and those close to them. However, unfortunately for practitioners it can also be emotionally tough and challenging. This is particularly the case when caring for someone with dementia towards the end of life. Continue reading

    200 years of Parkinson’s disease

    Gavin Gordon is a medical student from Newcastle University currently intercalating in the History of Medicine MA programme. He is the co-author of “200 Years of Parkinson’s disease: what have we learnt from James Parkinson?” recently published in Age and Ageing.

    The 200th anniversary of James Parkinson’s seminal Essay on the Shaking Palsy gives cause for commemoration and reflection. Parkinson’s astute observation and careful description of only six patients led to one of the earliest and most complete clinical descriptions of Parkinson’s disease. With the concept of a syndrome still not fully realised, Parkinson was among the first writers to unify a set of seemingly unrelated symptoms into one diagnosis. Continue reading

    A Taste of the BGS

    Fran Kirkham is an F2 doctor at the Royal Sussex County Hospital in Brighton, having graduated from the Cambridge Graduate Course in Medicine in 2016. She originally did an English degree at Cambridge University and worked in PR and Communications for 7 years. She hopes to pursue a career in Community Geriatrics.

    “So we drove on toward death through the cooling twilight.”
    ~ The Great Gatsby, F. Scott Fitzgerald

    An FY2 taster week can have a multitude of meanings. For some, it offers a reprieve from their mundane day job, almost as desirable as annual leave. For others, it is an opportunity to try a specialty that piqued their interest as a student. Yet others use it for cynical CV-building, knowing exactly to what profession they aspire and ‘proving commitment’ by spending an extra week doing the job they plan to do for the next 40 years. This may gain marks on the flawlessly-designed points-based applications which determine our chances of working in a specialty that bears any resemblance to our future career hopes or a location which is vaguely practical. Of course, a week is not realistically enough to get a sense of any job, nor ‘prove’ commitment to anything. But, as with many things in the NHS, this is the system in which we operate, so we make the best of it. Continue reading

    Practical palliative care after stroke

    Dr Ruth England is a Consultant in Palliative Medicine at Royal Derby Hospital. She tweets @DrRuthEngland. She will be speaking at the upcoming BGS event Living and Dying Well with Frailty on 6 March in London. Please note this event has now SOLD OUT.

    Palliative care is an active, holistic approach to those facing life-threatening illness. Good palliative care allows us ‘to live as well as possible for as long as possible’; and includes support for those approaching the end of their life.

    In the UK, someone suffers a stroke every 5 minutes. Although there has been a decline in stroke mortality, it remains a leading cause of death in those aged over 65.  There a high risk of dying immediately after an event, and 40% of those affected by stroke die within a year. Long term survivors are likely to be burdened with ongoing physical, psychological and social issues. Continue reading