July issue of Age and Ageing journal out now

The July 2016 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:

  • Frailty index based on basic laboratory and clinical measures
  • Dietary protein and ageing
  • Do you want to live to be 100
  • Social engagement and cognitive ageing
  • Selective serotonin reuptake inhibitors and progression of dementia

The Editor’s View can be read here.

This issue’s free access papers are:

March issue of Age & Ageing journal out now

The March 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:

  • New horizons in testosterone
  • Preventing delirium
  • Admissions for osteoporotic pelvic fractures and predictors of mortality
  • Cognitive motor interference

The Editor’s View can be read here.

This issue’s free access papers are:

Which one is a better deal – home visits or phone calls?

Frances Wong is a professor at the Hong Kong Polytechnic University. telemed

Our recent research has revealed very interesting findings about the power of a telephone call as compared to home visits for post-discharged patients. Patients are discharged from the hospital as soon as the immediate problems are resolved. Some care issues only emerge when the patients return home. The issues usually involve patients’ confidence and ability for self-care, symptom management, adherence to medication regimen and so on. If these concerns are not addressed properly, the patients will present themselves to the hospitals again. Like a revolving door syndrome, patients returning to the community come back to the hospital within a short time. The mean readmission rate within 28 days after discharge is 15% and the rate can escalate to 35% for the chronically ill patients.  Continue reading

A new approach to providing continence care in an ageing population

incontinence1Adrian Wagg is a Professor of Healthy Ageing at the University of Alberta, a regular author for the BGS Age and Ageing journal and General Secretary of the International Continence Society.

He will present a guest lecture on continence at the BGS Spring Meeting in March 2015. 

Incontinence is a hugely debilitating condition which affects millions of men and women worldwide.  Its incidence is rising as the proportion of people surviving into late life increases and with increasing rates of long-term conditions such as diabetes, heart disease and dementia for which it is a symptom or complication.  It has a huge impact on the lives of our patients and their caregivers, and comes at significant cost to health and social care services.  However, it remains one of the least discussed and most poorly understood conditions.

Earlier this year, along with colleagues Diane Newman, Kai Leichsenring and Paul van Houten, I undertook a review of the way continence service are organised, which was funded and supported by leading global hygiene company, SCA.

We concluded that there is a need for a greater focus on incontinence as a health and social care issue and to ensure that adequate resources are devoted to it.  In the UK, patients are still not being seen by the right professional at the right time.  The NHS needs to develop better models of multi-disciplinary working to ensure care is person-centred, and prioritises quality of life. Continue reading

Inappropriate drug use among older persons: is it time for action?

Andreas Schoenenberger works with the Division of Geriatrics, Department of General Internal Medicine at Bern University Hospital, and with the University of Bern, Switzerland. Here he describes his recent editorial in Age and Ageing journal, written with Andreas Stuck.Inappropriate Drug

Despite recent efforts to improve drug management for older people, we have not yet arrived at an optimal strategy for reducing inappropriate drug use. Drugs are considered inappropriate, if the risk outweighs the potential benefit of the drug. Along with pathophysiological changes during the ageing process, and the increasing number of co-morbidities/-medications, the potential risks of drugs increase with age and adverse drug reactions (ADRs) are encountered more frequently in older persons. Continue reading

January issue of Age and Ageing journal out now

The January 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:

  • Deprivation of liberty safeguards
  • Biomarkers for dementia
  • Clinical features of delirium
  • Physical therapy for knee osteoarthritis
  • Integrated care for older people

The Editor’s View can be read here.

This issue’s free access papers are:

Geriatric Medicine in the “little red dot”

Dr Liang Tee Lee is President of the Society for Geriatric Medicine, Singapore and a Consultant of Continuing & Community Care in Tan Tock Seng Hospital and Clinical Director at Ren Ci Hospital.shutterstock_183186191

Singapore is a city state country in South-east Asia, often marked by a little red dot south of Malaysia on the world map. It spans 716 square kilometres and has around 5.4 million people. Singapore is one of the fastest ageing countries in the world, with the population of 65 years and older projected to increase from 10.5% now to 18% in year 2030. Continue reading

The 12 Days of Christmas – a hospital doctor’s lament

4980cbdcDavid Oliver is the current President of the BGS, a visiting Fellow at the Kings Fund, and a consultant in geriatrics and acute general medicine at the Royal Berkshire NHS Foundation Trust.

This time last year, I wrote the “Geriatrics Profanisaurus” – all about words and phrases which should be banned when discussing older people. It triggered plenty of  responses “below the line”, adding to the list of ageist and ignorant language regarding healthcare for older people and went a bit “viral” online. Indeed, the BGS is now being followed by Roger Melly’s Profanisaurus on Twitter, as is occasionally “sweary geriatrician” Dr Wyrko.

As I started the precedent of a festive Presidential blog, I couldn’t resist my own re-write of the old favourite “The 12 Days of Christmas”. I say this as a frontline doctor who frequently disappears into an uber-busy acute medical unit, or emergency department and has inpatients who are increasingly frail and complex and often requiring step down health and social care services which are themselves over-stretched. It’s a very challenging environment both for staff, patients and families and one that I know colleagues right across the four nations face, especially in the winter months. Its important in letting off steam on this site – mainly read by clinicians, that we are all deadly serious about trying to provide the highest quality care for patients. So no fun is intended to be at anyone’s expense.

But here goes anyway: do join in, especially with a hearty “Five Interims”.

On the twelfth day of Christmas,
My true love sent to me:
Twelve “vacant” locums,
Eleven “bed meetings”,
Ten “points of access”,
Nine winter pilots,
Eight re-admissions,
Seven day working,
Six delayed transfers,
Five Interims,
Four hour breaches,
Three Iberian Nurses,
Two Norovirus,
and  an over-crowded ED…

I also sometimes find other songs going through my head that seem strangely appropriate to the jobs we all do. Here are one or two:

“Back in Black” …”I want my bed base back”  – with thanks to Los Bravos.

Or indeed “Back to Black” by Amy Winehouse. “Black Alert” that is – when we have as many beds as Bethlehem had room at the Inn. At such times, though I am a Man City Fan, “Simply Red” would be a welcome sight for once.

Talking of Amy, if I had a quid for every patient whom I have wanted to send to intermediate care for ongoing rehab, but has preferred either to stay in hospital or to go home with no rehabilitation and support, surely “They tried to make me go to rehab, I say No, No, No” fits the bill.

Allied to this is the Beatles “Hard Day’s Night” – not only applicable to overstretched on call teams and nurses but also when patients who don’t want to stay another hour in hospital say to me “Doctor, when I’m home…” and I do feel like replying “I know…everything seems to be right”.

Sadly it’s hard for many patients to understand that hospital consultants can’t click their fingers and magic up social care or community rehab places; I can see these patients singing Gwen Stefani’s “What you waitin’, what you waitin’ for?”

When it comes to falls resulting from postural instability, then we have to acknowledge the sage words of Miss Meghan Trainor: “It’s all about that Base”

Now over to the readers of this blog, for your suggestions! Nothing disrespectful or inappropriate, please or our Digital Media Editor will be in like Flynn and remove the post,  but if you can think of any more songs for the thread or any more lyrics for those twelve days, we’d like to hear from you!

Finally, let me wish you all a very Happy Christmas. And remember, winter pressures or not, the health service is an immensely rewarding place to work: our colleagues are troupers and caring for people at their neediest is a privileged occupation, however demanding it may be. But perhaps a bit of dark humour can help through the worst two clinical weeks of the year.

Integrated care – how to make a mountain out of a molehill?

David Stott is Professor of Geriatric Medicine at the Institute of Cardiovascular and Medical Sciences at the University of Glasgow and is Editor in Chief for Age and Ageing journal.shutterstock_183253856

Integrated health and social care has been promoted as a key solution to the challenge of providing high quality care with a restricted budget. Philp summarises current thinking in a New Horizons article recently published in Age and Ageing.

The aim of providing a fully integrated system including coordination of organisation of health and social services sounds sensible. After all who would argue for disintegrated and disorganised care?

However there are problems and challenges, not with the concept of integration, but in the organisation and systems that are being ‘pushed’ to effect integration. Continue reading

Proactive care of Older People undergoing Surgery (POPS)

Jude Partridge is a Clinical Research Fellow and Jugdeep Dhesi is a Consultant Geriatrician and Clinical Lead at Guy’s and St Thomas’ NHS Foundation Trust. They have recently reported on a UK survey of geriatric medicine delivered services in surgery in Age and Ageing journal.POPS

The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) has published another thorough and methodologically robust report, Lower Limb Amputation: Working Together. On this occasion they examined the care of the non-traumatic amputee across the UK and concluded that “only 229/519 (44.1%) of patients were receiving a standard of care with which the advisors would be happy for themselves or their family and friends. In other words, clinical management could have been better in half of the patients included in the study”.

Unsurprisingly, the majority of cases reviewed in this report were older, multimorbid and due to the lower limb amputation, at a transition point in terms of functional status. This older, multimorbid population were inadequately prepared for surgery (only two fifths of elective patients had preassessment) and commonly required medical input from a physician postoperatively (60%). So, did NCEPOD miss an opportunity to link past reports with this current review?  Continue reading