The National Audit of Intermediate Care 2014

Prof John Young is the National Clinical Director for Integration and Frail Elderly for NHS England. He is an Honorary Consultant Geriatrician, Bradford Teaching Hospitals and Head of the Academic Unit of Elderly Care and Rehabilitation at the University of Leeds. Here he updates his recent commentary published in Age and Ageing journal.

Some solutions can be hidden in plain sight. Those of us closely connected with intermediate care will certainly see these services as an important part of the solution for our overheated health and social care system. Perhaps it requires a time of austerity and an ageing population for the potential of intermediate care to be drawn into focus. The National Audit of Intermediate Care 2014 provides this focus. It allows us to take stock; to pose and receive answers to two fundamental questions: can intermediate care deliver good outcomes at an affordable cost; and, is it making a difference?

Dementia is not contagious

Daniel Sommer is a Core Medical Trainee in South East Thames. He is an aspiring Geriatrician. He tweets at @danielf90

I am committed to a career in geriatrics partly because I want to help people with dementia live safe, happy and productive lives. Working on an acute geriatrics ward is an amazing privilege. I’m constantly overwhelmed by the humanity of the staff that I work with. They seem to have endless patience and a genuine enthusiasm for what they do. In the face of huge challenges, staff shortages and under funding, our staff members provide an astonishing level of care for all patients, especially those with dementia. We have dementia boards, dementia boxes, dementia specialist nurses, dementia pins, dementia stickers and dementia clocks.

It feels silly telling an interested and educated audience [yes, that’s you!] about cognitive impairment, but I feel it’s important to be mindful of the scale of dementia and delirium in society and in the acute hospital. According to the Alzheimer’s Society, 7% of over 65s have dementia. A recent BMJ paper indicated that 34.8% of acute hospital in-patients over the age of 80 suffer from delirium, and 50.9% of those had an underlying dementia. This is not something than any healthcare professional can ignore.

With the above in mind, you’ll have to excuse me if I get more than a little bit irritated and hurt that some patients and their relatives are offended by the word “dementia” or that they demand to be moved off the “ward full of lunatics” because it’s “bad for their health”.

Book Review: Best of five MCQs for the Geriatric Medicine SCE

Samuel Blows is a SpR in Geriatric Medicine on the North East London rotation and has a particular interest in Medical Education. He tweets @blowsey

Best of Five MCQs for geriatric medicine SCE comprises three full mock papers each with one hundred questions. Following each paper there is a section with answers and detailed explanations.

The questions will give the candidate a fair idea of what to expect come the exam. The questions are challenging without exceeding what would be expected of a successful candidate. At the same time there is a comparable mix of subjects including questions about continence alongside questions about complex discharge planning. In addition to this the question “stems” mimic the length and detail a candidate would receive in the exam allowing the book to be taken as 3 separate “mock” papers or the candidate can work through it at his/her leisure.

Making difficult decisions about the benefits and risks of thrombolysis treatment

Dr Aoife De Brun is a Research Associate at the Institute of Health & Society at Newcastle University

An online survey investigating factors that influence clinical decision-making regarding intravenous thrombolysis for patients with acute ischaemic stroke has been launched. The project is funded by the NIHR Health Service and Delivery Research Programme and is led by researchers from Newcastle University.

We are recruiting clinicians who are involved in making the final decision regarding thrombolysis for patients with acute ischemic stroke.  By understanding how clinicians make difficult trade-offs between the potential benefits and risks of thrombolysis, we can design strategies to better support risk communication, consent and decision-making with patients in clinical practice.

New research highlights unseen dangers of pelvic fracture

A new study published in Age & Ageing finds pelvic fracture mortality rates equivalent to those for hip fracture, despite lack of attention or funding. 

The study into osteoporotic pelvic fractures in older patients has shown worrying effects on mortality, length of hospital stay and independent living.
It finds that mortality rates for pelvic fractures are comparable to those for hip fractures, but that the issue receives far less attention or funding. It calls for new guidelines and better management of pelvic fractures in older people, helping them to maintain an independent life.

Yousif Shanshal and Sheena Waters, co-authors of the report, said:

“Pelvic fracture patients incur a high cost to an already stretched NHS, with increased lengths of stay and high mortality rates. They are usually frail elderly patients with multiple comorbidities, and often don’t regain normal function after their injury.

Following the work of the National Hip Fracture Database and the Best Practice Tariff, care for hip fracture patients has improved across the country. We now need to do the same thing for pelvic fracture patients.

It’s crucial that these patients are cared for by a geriatrician, in close liaison with their orthopaedic colleagues, and that a multi-disciplinary team is fully involved in each patient’s recovery and discharge.”

November issue of Age and Ageing journal out now

The November 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:

• Guidelines for management of frailty
• Systematic review on sarcopaenia
• Inappropriate drug use in older people
• Co-morbidities in dementia
• Cost-effectiveness of telecare

The Editor’s View can be read here.

This issue’s free access papers are:

• Best practice guidelines for the management of frailty: a British Geriatrics Society, Age UK and Royal College of General Practitioners report

• Cost-effectiveness of telecare for people with social care needs: the Whole Systems Demonstrator cluster randomised trial
• Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS)

Many older adults still homebound after 2011 Great East Japan Earthquake

A new study, published online in the journal Age and Ageing today, shows that the homebound status of adults over the age of 65 in the aftermath of the 2011 Great East Japan Earthquake is still a serious public health concern. Of 2,327 older adults surveyed, approximately 20% were found to be homebound.

AsiaTravel / Shutterstock.com

A team of researchers led by Naoki Kondo of the University of Tokyo’s School of Public Health studied data from the city of Rikuzentakata, an area that was seriously damaged by the disaster. Of its total population of 23,302 before the events of 2011, 1,773 people died or are still missing. Of 7,730 houses, 3,368 (43.6%) were affected with 3,159 “completely destroyed”. Much of the population had been concentrated in flat coastal areas, and since the community infrastructure was totally shattered, many people who lost their houses insisted on moving to areas in the mountains.

What I do is who I am – the importance of activity in care homes

Lorraine Bridges is the Senior Communications Manager at the College of Occupational Therapists. She tweets at @L_Bridges

Occupational therapists help people to carry out essential occupations – the activities that make up our daily lives – from washing and dressing, the weekly shop, visiting friends and all the things we enjoy in life.  For older people occupations are vital for health, social inclusion, and mental wellbeing, but become more difficult due to increasing frailty. Geriatricians will be all too familiar with the serious risks of immobility.

The College of Occupational Therapists, like the British Geriatrics Society, firmly believes in equal access to health and social care and developed the Living Well Through Activity in Care Homes Toolkit to ensure that people living in care homes have the same access to occupational therapy as those living in their own home.  The resource is part of the College’s wider aim to champion dignity, choice, respect and control for older people, recognising occupational therapists’ unique skills in enabling occupation and understanding how dementia, co-morbidities, and other factors such as poor vision, impact on activity participation.

Good Vibrations: whole body vibration treatment

Falls are common in older people and are the direct cause of many osteoporotic fractures. There are limited treatments available to help frail older people who are at risk of falls. A study funded by the National Osteoporosis Society and the British Geriatrics Society on the potential benefits of whole body vibration for frail older people has now been published in Age and Ageing.

The collaborative work between the University of Loughborough and Nottingham University Hospitals NHS Trust showed that older people attending a falls prevention programme are able to tolerate whole body vibration.

Patients were recruited at The Nottingham University Hospitals Rehabilitation Unit and all of them took part in the NICE recommended falls prevention programme, which includes exercise. They were split at random into three groups. One group used a vibration platform that moved vertically up and down; one used a vibration platform with a “see-saw” action and one group stood upon a stationary platform whilst a buzzing noise was played so that they thought they were receiving vibration (sham vibration). The vibration training involved visiting the unit three times per week over 12 weeks, and standing on the plate during several short bouts of vibration, for a maximum of 6 minutes in total.

Empowering Allied Health Professionals – opportunity to attend valuable conference

Empowering allied health professionals to transform health and care services

 

THIS OPPORTUNITY HAS NOW CLOSED – a successful applicant has been chosen.

Thanks to everyone for getting in touch!

See here for this conference, which is of interest to all AHPs

 

The British Geriatrics Society is offering a free place at the above conference for an allied health professional, as an opportunity for personal development and to help share the learning from this important meeting.