No Les, No Moore

5801631762_dd88709954_oPaula Shepherd is a University Practice Learning Adviser for Bournemouth University; supporting pre-registration health education in practice. @pshepherdBU

‘Here lies Lester Moore, 4 slugs, from A44, No Les, No Moore’

At the age of 14, I received the ‘A Small Book of Grave Humour’ in my Christmas stocking. It contains tombstone inscriptions which reflect characteristics of the person memorialised or, should I say, the person selecting the stone. An odd selection for a child, but even at that formative age I realised that we all live on in some form, what we do influences the way the world works; has an impact. So why, I wonder, do we seem so reluctant to incorporate life and death as unified progression? Continue reading

Older people want more opportunities to plan their care

aaPatients are increasingly planning for end-of-life care, but services aren’t always available, reveals new study.

Older people who want to talk to health professionals about advance care planning (ACP) are not always able to do so, a new study published in Age & Ageing has revealed.

More than a third of respondents in the East Midlands study said that they would be interested in discussing advance care plans with a health professional. However, only 17% of respondents had prepared an advance care plan, and only 5% had been actively offered the opportunity to talk about it with a health professional.

Advance care planning is a process of assessment and dialogue to document an individual’s preferences for future care and treatment. It can result in ‘advance’ directives (often referred to as ‘Living Wills’) which record views on specific treatments; the nomination of a proxy to represent the individual if they lose mental capacity; and statements of values and views about care and treatment.

This study received responses from 1,823 people aged 65 and over, living in community settings, and indicated an increase in the number of patients putting advance care plans in place (up from 8% in a 2005 poll). The study concludes that these results should encourage healthcare professionals to explore what people understand by ACP, and the role of professionals in providing it.

Corresponding author Irfana Musa of Leicester Royal Infirmary said:

“With the population growing older and living longer, we are treating many more conditions such as dementia, in which an individual’s decision making ability becomes impaired. Advance Care Planning can help people think ahead and also inform others of their wishes in anticipation of a time when they cannot communicate themselves.

This study gives us a flavour of what the population understand by Advance Care Planning, whether they would engage in the process, and what the barriers might be.”

Speaking on behalf of the British Geriatrics Society, Prof. Adam Gordon said:

“Doctors and health care professionals often feel nervous about exploring issues around advance care planning in case they offend or unduly distress patients. This sometimes stops them preparing these plans in discussion with patients, even when they think it might be in a patient’s best interests.

This study tells us they should be less nervous and more forward in introducing advance care planning concepts. Such discussions, though, can take time and this is one of many reasons we need to reflect upon the time available to general practitioners for routine consultations in older patients with frailty and work to increase resources in primary care to support patient-centred care planning.”

BBC documentary series ‘Protecting our Parents’

Protecting Our Parents

Dr Peter Wallis, formerly consultant geriatrician – Birmingham Heartlands Hospital, was involved with the filming of a new BBC 2 Documentary Series

The department of elderly medicine at Birmingham Heartlands Hospital became aware of the BBC‘s interest in a documentary series about the care of older people following an advertisement in the British Geriatrics Society Newsletter (2012) placed by the BBC Bristol Documentary team.   The intention was to produce a 3 part documentary series reflecting current issues in the health and social care of older people. Following successful discussions and with the agreement of partner organisations including social services as well as primary, community, mental health and ambulance service teams, filming took place during 2012/13. Filming was centred around the elderly care and general wards as well as the A&E department at Birmingham Heartlands Hospital and the patients with their stories were followed into community settings.

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Clinical Commissioning Group – Why not join one?

Dr Ian Donald, consultant geriatrician with special interest in community care, health service development and management of frailty, urges geriatricians to join a clinical commissioning group and describes his own experience of being part of a CCG. thirdSector
When Clinical Commissioning Groups (CCGs) were formed in April 2013, the legislation under the Health and Social Care Act 2012 envisaged that the CCG would be a new body built upon GP practices, which together make up the membership of the commissioning group. This “practice-led” GP commissioning was then amended to “clinically-led” commissioning. As a result, Secondary Care physicians have a statutory role on the governing body of each CCG. It was envisaged that:- “Individual members of the governing body will bring different perspectives, drawn from their different professions, roles, background and experience. These differing insights into the range of challenges and opportunities facing the CCG will, together, ensure that the CCG takes a balanced view across the whole of its business.” The regulations state that the Secondary Care Doctor should either be in practice or recently retired, and should not be an employee of an organisation which has a commissioning contract with that CCG.

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Healthcare for UK care home residents is broken. How should we go about fixing it?

Adam Gordon is a Consultant and Honorary Associate Professor in Medicine of Older People based in Nottingham, UK.  He also edits this blog.shutterstock_45287182

A lot of excellent practice takes place in care homes. This is contrary to the image portrayed in the lay media, where there seems to be near-universal agreement that long-term care in the UK is “broken”. The same media reveals less agreement about what aspects of long-term care, precisely, are broken.  Conversely, there is no shortage of suggestions about how one might go about fixing it.

Often overlooked in these discussions is the fact that healthcare provision to care home residents is the responsibility of the National Health Service.

Failure to meet the healthcare needs of residents must therefore reflect, to some extent, on the NHS and how it organises care for them.

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Making Health and Care Fit for an Ageing Population.

Kings Fund and BGS Conference: BGS President Elect, David Oliver, describes how this conference ties in to the work of the BGS and the Department of Health’s new proposals to improve care for vulnerable older people.

On 22 October, the Kings Fund is hosting a one day event on making health and care services fit for an ageing population. This event is supported by the BGS and several of our members are speaking. I am fortunate to have a foot in both camps as BGS president-elect but also as a Kings Fund Visiting Fellow. We have timed the event to coincide with the planned autumn announcement by Rt Hon Jeremy Hunt MP – Secretary of State for Health – of the Vulnerable Older Peoples Plan. Mr Hunt is due to speak at our event and announce some further details. Continue reading

Unco-ordinated care: we need named responsible clinicians in hospital too!

Ron Murphy is a software designer, he blogs at card

I read the “Named clinicians …” post today, and the linked post by Prof David Oliver. It addresses continuity of care after discharge. This is a concern, as he quotes, “we need to know that there is a clinician accountable for vulnerable older people in the community, just as there is in hospital”. Continue reading

What is the future of care for the dying?

Kate Granger is an Elderly Medicine Registrar at Pinderfields Hospital in Yorkshire. She tweets at @GrangerKate and blogs at shutterstock_137790233


As a vocal advocate of the Liverpool Care Pathway I have experienced a wide range of emotions since the publication of the Independent Review regarding its use, ‘More Care, Less Pathway’.

Initially I was shocked something which had become a routine part of my post registration working life was going to be scrapped. I cannot recall such a prominent change in practice since I qualified. Personally I always found the LCP a very useful framework to employ when caring for dying patients.  As the shock subsided I will admit to some negative emotions; I was upset and angry but mostly disappointed; disappointed that our efforts to dispel the media misrepresentation and scaremongering had been in vain. A feeling of indifference followed. This is a rare feeling for me to experience when it comes to anything Palliative Care related; I am usually so passionate. Continue reading

Newsflash: Acute Care system fails an older patient, reflections from a relative

Ron Murphy is a software designer, he blogs at ronmurp.netthumbnail

An older patient presenting acutely to A&E in an unwell and frail state can erroneously be assumed to be at their baseline pre-morbid state, with some additional new complaint like a “UTI” as an over-riding diagnosis. My active and mobile mother was reduced over a period of three months to a delirious crumpled wreck who didn’t know what day it was because of a persisting UTI that had not been dealt with. Her past medical history was complicated: stroke, heart attack, pacemaker, diverticulitis, arthritis, diabetes not well controlled, kidney function not right … you get the picture. But still, before the UTI she was sharp and active.

What follows is a brief account (you don’t want the detailed version) of what happened in A&E on three failed visits. Continue reading

Time to get end of life care right?

Kate Granger is an Elderly Medicine Registrar at Pinderfields Hospital in Yorkshire. She tweets at @GrangerKate and blogs at

As Geriatricians I strongly feel one of our most important roles is providing Palliative Care in the acute hospital and within other settings such as nursing homes. We only have one opportunity to get this right and getting it wrong can cause lasting, irreparable damage to those left behind.

As a terminally ill cancer patient, diagnosed at the age of 29 with a rare and aggressive sarcoma, these aspects of care have been brought into even sharper focus. Death is not an abstract concept for me; it is a reality in my foreseeable future. For the moment, though, I remain well enough to work part-time as a Specialist Registrar in Geriatrics. Continue reading