Palliative care provisions are not meeting the needs of an ageing population

A commentary published today in Age and Ageing, the scientific journal of the British Geriatrics Society, warns despite the fact that frail older people with multiple illnesses and end stage dementia are the most rapidly growing group in need of palliative care current provisions are not aligned to meet their needs.

The authors of the commentary noted that current projections indicate that between 25% and 47% more people may need palliative care by 2040 in England and Wales. A high proportion of these people will die following a prolonged period of increasing frailty and co-morbidity including cancer, but also other long-term conditions such as heart failure, chronic obstructive pulmonary disease, diabetes or renal failure. 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

    Using a frailty index in the Emergency Department

    Dr Audrey-Anne Brousseau is the first fellow in geriatric emergency medicine in Canada. She was recently appointed as assistant professor at the Université de Sherbrooke in Quebec. Her work focuses on developing best practices for older adults in the emergency department.

    EDs are often the safety net of the health care system where the mission is to (rapidly) evaluate, intervene and organize transitions of care. With the aging of the population and the growing presence of older adults in EDs, this mission represents a significant challenge because older adults are complex on multiple levels.

    How do we determine whether a patient is fit to go back home — or not?  Needs admission —  or not? Would benefit from rehabilitation, additional community services, further assessment — or not?  A comprehensive geriatric assessment will provide this answer, but is rarely readily available in most EDs. Moreover, human and material resources are often limited in public health care system preventing all older adults ED patients to get a geriatric assessment and appropriate interventions. Continue reading

    World first study reveals admitting an older relative in temporary respite care can be a deadly mistake

    A world first study into deaths of Australians admitted into aged respite care – usually to provide a planned or emergency break for their carer – reveals that older people in respite care are significantly more likely to die from preventable injury causes such as falls than those who are permanent nursing home residents.

    The study found that preventable deaths from choking are twice as high as for long term residential care. Other preventable deaths such as from suicide are also higher in these temporary residents.

    The research – published in Age and Ageing journal, by Monash University researchers – has serious implications for the 80% of older Australians who are cared for in the community by spouses, family members and friends. Of these more than 50,000 go into temporary respite care each year. Continue reading

    Number of older people with four or more diseases will double by 2035, say researchers

    A study published recently in Age and Ageing, the scientific journal of the British Geriatrics Society, reports that the number of older people diagnosed with four or more diseases will double between 2015 and 2035. A third of these people will be diagnosed with dementia, depression or a cognitive impairment.

    The study, conducted by researchers at Newcastle University’s Institute for Ageing, found that over the next 20 years there will be a massive expansion in the number of people suffering from multiple diseases, known as multi-morbidity. As a result two-thirds of the life expectancy gains, predicted as 3.6 years for men, 2.9 years for women, will be spent with four or more diseases. Continue reading

    Predicting who will be admitted to a care home from hospital?

    Jenni Burton is a Clinical Research Fellow in Geriatric Medicine funded by the Alzheimer Scotland Dementia Research Centre and the Centre for Cognitive Ageing and Cognitive Epidemiology at the University of Edinburgh. Here she discusses the results of two linked systematic reviews of predictors of care home admission from hospital. She tweets @JenniKBurton.

    Care home admission from hospital has long been recognised as an area of significant variation in practice (Oliver D et al. 2014. Making our health and care systems fit for an ageing population) and one which remains a strategic target to reduce across the UK. However, more than half of care home admissions each year in Scotland come directly from hospital settings. It is therefore important to explore the predictors of this life-changing transition to help inform prognostication, communication with individuals and their families, service planning and the extent to which we can intervene to prevent or modify this outcome.  Continue reading

    HIV and Older People

    World AIDS Day is dedicated to fighting stigma and discrimination, and raising awareness of the HIV/AIDS pandemic. We mark this day by, in turn, raising awareness of older people with HIV.

    Incidence and prevalence of HIV in older people is increasing. In the UK one in five adults with HIV is aged over 50. This is a consequence both of the expansion in uptake of HIV testing and diagnosis and major improvements in treatments which are helping people with HIV to live longer.

    The fact that older people with HIV are living longer where there is access to treatment is a cause for celebration but it also brings challenges for geriatric medicine. Older people with HIV commonly experience co-morbidities such as cardiovascular disease, osteoporosis and dementia. Medical management of HIV in older people requires considerations of complex drug interactions and co-morbidities.

    Early diagnosis of HIV is key to improving prognosis. Treatment with highly active anti-retroviral therapy (HAART) significantly prolongs life expectancy, however it is associated with an increased risk of side effects in older patients. Continue reading

    Older people are living longer than before, but are they living healthier?

    Ruby Yu is a research assistant professor at the Chinese University of Hong Kong (CUHK), specialising in gerontology and geriatrics. She is also a research fellow at the CUHK Jockey Club Institute of Ageing. Her recent paper Trajectories of frailty among Chinese older people in Hong Kong between 2001 and 2012: An Age-period-cohort Analysis was published today in Age and Ageing journal.

    There is no doubt that people from countries all over of the world are living longer, but there is little evidence to suggest that older people today are living healthier than their predecessors did at the same age. This is a major cause of concern for many governments around the world because if the added years of people today are dominated by chronic diseases and functional disabilities, there will be negative implications (e.g., extended treatment for older people which increases the health and social care cost to society). Continue reading

    Catching some zzz’s with Z-drugs? You might want to reconsider

    Dr Ilan Matok heads the pharmacoepidemiology research unit in the Hebrew University of Jerusalem’s School of Pharmacy, and directs research evaluating the safety of medication. Their research was recently published in Age and Ageing.

    Insomnia is a very common medical complaint, and increases with age. Patients with insomnia often report increased daytime fatigue, confusion, anxiety, and depression. While insomnia can have a significant negative impact on quality of life, a recent study highlights the need for careful consideration in the use of sleeping medication to manage this condition, especially among older adults.

    It is widely recognized that the use of traditional “benzodiazepine” type sleeping medication (e.g. nitrazepam), increase the risk of fractures and falls in older adults. However, less is known about the safety of “non-benzodiazepine” sleeping medication, otherwise known as “Z-drugs” (e.g zopiclone). In fact, these drugs have been marketed as safer than benzodiazepine medication, and are often perceived as such by clinicians and patients alike. Continue reading

    ‘We don’t need no education…’ Teaching about delirium in medical schools

    Dr Claire Copeland is a Consultant Physician in Care of the Elderly and Stroke Medicine at Forth Valley Royal Hospital. Her paper Development of an international undergraduate curriculum for delirium using a modified Delphi process has recently been published in Age and Ageing. She tweets at @Sparklystar55

    Back in 2015 a workshop at the European Delirium Association (EDA) conference was held to bring together a group of delirium experts. Its purpose? To develop a consensus agreement on a delirium curriculum for medical undergraduates.

    Most of you reading this I’m sure will be familiar with delirium. It’s technically been around for centuries. However there are many working in healthcare who still do not know about it. Or if they do, they refer to it by every other name except delirium. Continue reading