May issue of Age and Ageing journal out now

The May 2014 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:

• Cataract surgery and falls
• Risk factors for delirium
• Perceived age discrimination
• End of life care in nursing homes
• Cluster randomised trial of telecare and quality of life

The government and the “societal benefits” of care

Zoe Wyrko is a Consultant Geriatrician at Queen Elizabeth Hospital Birmingham and is the workforce planning lead for the BGS. She tweets at @geri_baby

I like to think that as a jobbing geriatrician I have a fairly pragmatic attitude towards guidelines. I know that they exist, but I also know that they are not always directly applicable to a frail older person with multiple morbidities, so I’ll look at what they say with a hint of scepticism, and use them when they help me to provide the best care. Extrapolating from this, I tend to see NICE as an organisation that is more for other people than me. I know that the work they do is vital in standardizing care, bringing together groups of experts to decide on treatment pathways and helping to make decisions on which drugs to give when. I have even attended a stakeholder group for the preliminary stages of the guidance they are planning to issue for social care.

This week however, a statement made by Sir Andrew Dillon, head of NICE, has made me sit up and pay attention. It seems we should be afraid… very afraid.

The Geriatrics “Profanisaurus.” Words and phrases we should ban?

David Oliver is a Consultant Geriatrician in Berkshire and a visiting Professor in Medicine of Older People at City University, London. He is President Elect of the British Geriatrics Society. 

During the BGS Spring Meeting in Belfast, Prof Des O’Neill – probably the most cultured and literate geriatrician in our midst, asked many delegates, notebook in hand,  for tips on enlightening books to further his thirst for broad knowledge. Earnest as ever, I suggested George Haidt’s “The Righteous Mind” and Ha-Joon Chang’s “23 Things They Don’t Tell You about Capitalism!”. Our then Hon. Sec., the redoubtable Dr Zoe Wyrko, mischievously and persistently tried to persuade Desmond that the book he really needed was “Roger Melly’s Profanisaurus” from Newcastle’s Booker-winning publishing house, Viz magazine. I did have a wry smile at the idea of the Amazon package being eagerly opened in Dublin the following week –contents taking pride of place in vertiginous O’Neill bookshelves. I also got to thinking, “sod Roger” – what about “Dave’s Profanisaurus of Geriatric Medicine?”. 

Fitness not Age – The Determining Factor for Health and Social Care

The assessment of older people’s fitness levels may become necessary in routine health and social care practice, argues an editorial published in Age and Ageing.

European populations are getting older in chronological, but not necessarily biological, terms. The association between chronological age and health status is extremely variable and decisions made in health and social care based solely on age do not reflect the complexity of older people.  The Equality Act came into force in October 2012 and gives older people the right to sue if they have been denied health and/or social care based on age alone.  The aim is to ensure that people are clinically assessed on the basis of their individual needs and fitness levels.

‘Fit’ individuals are resilient whereas ‘frail’ individuals are vulnerable and have an increased risk of adverse outcomes, including iatrogenesis, functional decline and death.  Frail individuals can benefit from specialist multidisciplinary care and interventions but require careful identification and management.  How do you determine where an individual sits along the fitness-frailty spectrum? ‘Fitness’ and ‘frailty’ are opposite ends of a challenging continuum and while experienced practitioners can (and often do) intuitively place their patients along that imaginary spectrum, this subjective ‘clinical impression’ of vulnerability may not be sufficient in the eyes of the Equality Act.

However, there is as yet no consensus on formal ‘frailty metrics’.  Being able to place a person along the fitness-frailty spectrum independently of their age will become crucially important in the years ahead, both to advocate for resource and to target specialist care appropriately.  Equality legislation should minimise instances of ageism and age discrimination but we need agreement on appropriate frailty metrics for health and social care to ensure that all individuals receive the most beneficial interventions.

Age and Ageing collection: The Recruitment of Older People to Research

Prof Gordon Wilcock is Vice President for Academic Affairs at the British Geriatrics Society, is Emeritus Professor of Geratology, University of Oxford.

A collection of 10 Age and Ageing papers is free to view on the journal website.

Concern has been expressed for a long while about the lack of older people included in clinical trials. However, the inclusion of older people in research in general is a subject worthy of attention. There are many reasons why it is sometimes difficult to recruit people over 70 into research. Some of these are self-evident, e.g. the presence of co-morbidities leading to travel difficulties, reluctance to take on something that may be onerous, cultural divisions, language barriers, research skills capacity, a greater risk of ill health, and the reluctance of family members to support an elderly relative in a research project.

Interesting times indeed – the Francis Report and Care of Older People

Prof Paul Knight is President of the BGS and is Director of Medical Education and Consultant Physician at the Royal Infirmary, Glasgow.

The oft quoted expression, “may you live in interesting times”, not as approbation, but as a threat, certainly seemed to apply recently.

Apparently, it probably isn’t a Chinese proverb but appeared in a science fiction novel in the 50’s. As I was preparing my contribution to this edition of the newsletter the Francis report was released. There will be much about the report elsewhere in this and subsequent newsletters, as we consider what it means to the way we work.

Inevitably, Francis means most to colleagues working in the NHS in England, but I would urge all to review the Executive summary, not least because Robert Francis will be an invited speaker at the Belfast Spring Meeting and it will give you some context. The recommendations for regulators such as the GMC and NMC will apply UK wide and not just in England.