Take time to talk! The importance of an informant history

Adam Dyer is a Final Year Medical Student in Trinity College Dublin. Dr. Sean Kennelly (MB PhD FRCPI) is a Consultant Physician in Geriatric and Stroke Medicine in Tallaght Hospital (Dublin, Ireland) and a Clinical Senior Lecturer in Medical Gerontology at Trinity College Dublin (TCD). The following work was presented as a platform presentation at the 64th Irish Gerontological Society Meeting in Killarney, Ireland (October, 2016).

Imagine you’re seeing a consult or you’re on a post-take ward round. How often do we examine a patient and identify cognitive deficits, see that the CT brain scan report and the MMSE score are readily on hand, but then ask staff about the patient’s premorbid cognition and function and are met with blank expressions?

An important factor which complicates the presentation of older people to acute hospitals is the presence of impaired cognitive status (either in the form of dementia, delirium or both). Continue reading

New Collaboration Looks for Trans-Atlantic Common Ground in Geriatrics

Top research journals launch international editorial series tackling the latest in geriatrics clinical practice & public policy. Up first: commonalities “across the pond” for older adults with multimorbidity.

Healthcare professionals across the Atlantic and around the world need to think beyond single-disease guidelines as they look to provide high-quality, person-centered care for more and more older adults living with multiple chronic conditions, so say editors from the Journal of the American Geriatrics Society and the British Geriatrics Society’s (BGS’s) Age and Ageing in the first from a series of joint editorials launched today. The series will look for common ground in geriatrics “across the pond,” beginning here with the U.K.’s National Institute for Health and Care Excellence (NICE) guideline on multimorbidity, the medical term for those living with several chronic health concerns. Continue reading

Unchain me: how our approach to safety leads to harm

Professor Joseph Ibrahim is Head, Health Law and Ageing Research Unit at Monash University’s Department of Forensic Medicine and the Clinical Director of Geriatric, Rehabilitation and Palliative Care Medicine, at a large regional health service in Australia. Joseph has a keen interest in promoting better care for older people and edits the Communiqués printed educational material designed for health professionals to learn from cases investigated by the Coroners Court. Learn more about Joseph on his personal website.

Joseph and the team recently completed a landmark Australian study published in Age and Ageing, examining deaths due to physical restraint of people living in nursing homes. The study found that five deaths were recorded in nursing home residents due to physical restraint over the 13-year period. The median age of the residents who died was 83 years; all residents had impaired mobility and had restraints applied for falls prevention; four had diagnosed dementia. The mechanism of harm and cause of death were ascertained by a forensic pathologist following autopsy and in all cases, were formulated as ‘neck compression and entrapment by the restraints’. Continue reading

Systematic biases in death certification: a job for the Medical Examiner?

Katherine Sleeman is an NIHR Clinician Scientist and Honorary Consultant in Palliative Medicine at the Cicely Saunders Institute, King’s College London. In this blog she discusses her recent Age and Ageing paper on death certification in dementia. @kesleeman

portraitIt is frequently said that there are just two universal certainties: death and taxes. While HMRC is responsible for ensuring that taxes are paid, information about who dies, where, and how, is gathered through death certification.

Dementia is a public health priority of increasing importance. In 2014, it was reported that dementia had overtaken cancer and cardiovascular disease as the most common cause of death for women in England. We have previously shown that the proportion of death certificates in England where dementia was mentioned as a cause of death doubled between 2001 and 2010.

But what is unclear is why dementia deaths appear to be increasing. Is it due to an increasing prevalence of dementia in our ageing society? Due to increased detection of dementia, perhaps? Or does this increase simply represent an improvement in death certification practices over time? Continue reading

November issue of Age & Ageing out now

The November 2015 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 this issue include:

  • Retirement and sedentary behaviours
  • High-velocity resistance training
  • Single versus shared rooms in hospital
  • Antihypertensives in frail older people
  • Inflammation and frailty

The Editor’s View can be read here.

This issue’s free access papers include:

Popular treatments for lower urinary symptoms may be doing more harm than good

aaA new study published in Age & Ageing, the scientific journal of the British Geriatrics Society, has revealed that many of the drugs commonly prescribed for older people with lower urinary tract symptoms may be doing more harm than good, and should either be used with caution or avoided altogether.

Researchers from the University of Heidelberg and an international rater team analysed data from 25 different clinical trials and other available evidence. Of the 16 drugs included in the study, only three were classified as beneficial for older people.

The majority were rated as questionable, meaning they should be avoided where possible, especially when patients are receiving other drugs at the same time. Five drugs were rated as “avoid”, with the authors recommending that they should not be used for older patients at all.

Drugs for the treatment of lower urinary tract symptoms rank amongst the most frequently prescribed medications for older people, and yet this new research is the first systematic comparative study looking at their appropriateness for older patients.

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

“Lower urinary tract symptoms are common in older patients and can be a source of considerable distress. There is increasing recognition that many of the drugs prescribed for lower urinary tract symptoms may have harmful side-effects, particularly related to memory and thinking. 

Against that background, this study is a timely reminder that there is limited evidence of benefit in older patients for many drugs used. This has a number of implications. 

Firstly, drugs should only be used where non-drug treatments have been shown not to work. Secondly, they should be used with careful attention as to what side-effects they may be causing. Thirdly, more research is required to understand what combination of medications will achieve the best outcomes in older patients with lower urinary tract symptoms.”

Martin Wehling, corresponding author of the study said:

“The FORTA (Fit fOR The Aged) system – a simple approach to label drugs to be used in older people from A (indispensable), B (beneficial), C (questionable) to D (avoid) – was applied here to separate beneficial from less favourable drugs.

It is meant to provide guidance at a glance to improve often complex medication schemes which are all too common and carry considerable risk in this important age group. The respective FORTA list classifies drugs to treat major indications, with a new chapter on those used for lower urinary tract symptoms now added.”

Health & social care costs: big data, or huge problem?

UntitledRachel Elliott and Matthew Franklin are reporting on behalf of the Medical Crises in Older People (MCOP) research team. Read the first part of their blog on identifying health & social costs here.

As part of a programme developing and evaluating care in older people, our recent study in Age and Ageing reports health and social care costs over a three month period for older people discharged from Acute Medical Units (AMU) by applying unit costs to patient-level data obtained from six different agencies: hospitals, primary care, social care, mental healthcare, ambulance services, and intermediate care. This is the first study to do this in England, but obtaining resource use data from individual services for this analysis took months, which was costly and of no use for real time patient management.

Continue reading