Qualitative Research in Age and Ageing

This themed collection of Age and Ageing articles includes a selection of papers published over the last 10 years which highlights the value of qualitative methodologies in health services research, particularly in understanding patient experience of health and illness and decision making about treatment and preventive care. We hope this issue will raise awareness of the scope for further contributions and encourage authors to submit papers reporting qualitative studies to the journal.

Summary of topics and themes:

In an editorial in Age and Ageing ⁽⁵⁾, we drew attention to the way in which the application of qualitative research methods within the social science disciplines of sociology, anthropology and social psychology can enrich understanding of ageing and illness: for example, through eliciting the meaning and process of ageing, health and illness from the perspective of older people; the practice of service delivery and what shapes it; and the beliefs, values and ‘taken for granted ‘knowledge that professionals may apply in their work with older people.

‘Five a day’ keep dementia away, say researchers

Having at least 3 servings of vegetables and 2 servings of fruit daily might help prevent dementia in older adults according to a study published today in Age & Ageing, the scientific journal of the British Geriatrics Society.

The study, which was conducted by researchers at the Chinese University of Hong Kong, followed the cognitive status of 17,700 dementia-free older adults for 6 years. The objective was to investigate whether those consuming at least 3 servings of vegetables and 2 servings of fruits daily, in line with the World Health Organisation recommendation, were at a lower risk of developing dementia.

Frequent sauna bathing protects men against dementia

Jari Laukkanen is a professor at the University of Eastern Finland. He and his co-authors have recently published a research paper in Age and Ageing journal on the link between sauna bathing and memory diseases. You can follow him on twitter @LaukkanenJari

Frequent sauna bathing can reduce the risk of dementia, according to a 20-year follow-up study.  Men taking a sauna 4–7 times a week were 66% less likely to be diagnosed with dementia than those taking a sauna once a week. The association between sauna bathing and dementia risk has not been previously investigated.

The effects of sauna bathing on the risk of Alzheimer’s disease and other forms of dementia were studied in the Kuopio Ischemic Heart Disease Risk Factor Study (KIHD), involving more than 2,000 middle-aged men living in the eastern part of Finland.

How do geriatricians improve outcomes after hip fracture?

Jenny Neuburger is a Senior Research Analyst at the Nuffield Trust  (@NuffieldTrust) and a Visiting Research Fellow at the London School of Hygiene & Tropical Medicine. She and her co-authors have recently published research in Age and Ageing journal.

We have just published a paper showing that geriatrician involvement in hip fracture care can improve patient outcomes.  Patients treated on wards with higher numbers of geriatrician hours tended to have lower mortality within the 30 days after presentation.

We measured geriatrician hours worked in orthopaedic departments using data collected via the National Hip Fracture Database annual survey each year from 2010 to 2013 for English hospitals.  Over this period, geriatrician hours increased from 1.5 to 4.0 hours per patient, reflecting investments made in response the financial incentives introduced under the Best Practice Tariff scheme.

A New Holistic Approach to Pain Management in Older People

Nan Ma is specialist registrar in clinical Gerontology and Aza Abdulla is a consultant geriatrician and general physician at the Princess Royal University Hospital, Kings College NHS Foundation Trust. He is co-founder of the Special Interest Group on Pain in Older People in the British Geriatrics Society (BGS) and participated in producing the first National Guidelines on Management of Pain in Older People. He is also the immediate past president of the Geriatrics & Gerontology Section at the Royal Society of Medicine.

Pain in older people is under-reported and often poorly appreciated. For many, it is seen as part of normal ageing and has to be accepted. It is also a subjective feeling (different people have different pain thresholds) making it difficult for the clinician to quantify its impact in an individual patient. Consequently, it may be overlooked as an important factor that can affect older people’s wellbeing. In fact, chronic pain has a huge influence on quality of life (QoL) through its effects on the physical and mental state, which in turn adversely impacts on the older individual’s economic and social status (effects on carers, friends and family). Inadequately controlled pain perpetuates disability, anxiety, and depression all interfering with the overall QoL. It follows that effective management of pain is crucial in optimising welfare in the older person.

How can hospitals empower older people with advanced disease?

Dr Lucy Selman is Cicely Saunders International Faculty Scholar in the Department of Palliative Care, Policy, and Rehabilitation at King’s College London, and a Research Fellow at the University of Bristol. In this blog Lucy discusses her recent Age and Ageing paper on an international study of patient empowerment in hospitals in London, Dublin and San Francisco (part of BuildCARE, a project led by Prof. Irene J. Higginson at King’s College London).

Empowered patients adopt healthier behaviours, use health services more cost-effectively, and experience better quality of life than patients who feel they are passive recipients of healthcare. Across the developed world, policy-makers are waking up to the benefits for patients and health services when people are encouraged to engage with clinicians, make decisions and manage their illness in a way that reflects their own values.

Only half of people with dementia get annual medical review

Claudia Cooper is an honorary consultant old age psychiatrist with Camden and Islington NHS Foundation Trust. She focuses on research related to dementia and mental health in older age. Here she discusses her recent Age & Ageing paper Inequalities in receipt of mental and physical healthcare in people with dementia in the UK.

People with dementia experience more mental and physical health problems than people without dementia, and more frequently take medication for mental health problems, so ensuring the get fair access to mental and physical healthcare is important.

Our study looked at primary care records of 68, 061 people with dementia and 259,337 people without dementia between 2002 and 2013. We looked at how rates of mental health medication prescribing (antipsychotic, antidepressant and sedative drugs);  contact with General Practice surgeries and physical health checks  (blood pressure, weight monitoring and an annual review) varied between people living in more and less deprived areas, and between men and women.

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

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

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

6. 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.

Getting to grips with multimorbidity and polypharmacy for older people

Dr Kevin Mc Namara is a Senior Research Fellow at Deakin University’s School of Medicine and Centre for Population Health Research. He has a particularly interest in the implementation of models for chronic disease prevention and management, including the management of multimorbidity. His paper, Health professional perspectives on the management of multimorbidity and polypharmacy for older patients in Australia, has been published in Age and Ageing.

Researchers from Australia offer some valuable insights about effective multidisciplinary care for older people who often have multiple health conditions (multimorbidity) and take multiple medications (polypharmacy). In ageing populations across the developed world, multimorbidity and polypharmacy pose unique and growing challenges for health professionals and systems. Treatments and goals for different health conditions are often not compatible, guideline recommendations may not be feasible, the evidence often lacking for older adults, and health systems are not designed to coordinate the activities of multiple health professionals often involved with care.

Hypertension and dementia: exploring the evidence

Jenni Harrison is a Clinical Research Fellow at The University of Edinburgh. Her previous role was as an Academic Clinical Fellow in Geriatric Medicine in Leicester. She was part of the Hypertension in Dementia (HIND) Research Group at the Universities of Nottingham and Leicester. The group recently produced a New Horizons article on the management of hypertension in people with dementia. She tweets @JenniKHarrison.

In the face of uncertainty around the optimal management of hypertension in people with dementia we sought to review and summarise the available evidence. After first considering the rationale for the treatment of hypertension and possible reasons why the approach could be different for those with dementia, we structured our review around three key questions:

(1) Do people with dementia experience greater adverse effects from antihypertensive medications?

(2) Is cognitive function protected or worsened by controlling blood pressure?

(3) Are there subgroups of people with dementia for whom antihypertensive therapy is more likely to be harmful?