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. ProfantaClaus

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?”.  Continue reading

Preventing and stopping abuse

Mary Cox, Safeguarding Advisor for Age UK will be speaking at the British Geriatrics Society Autumn conference in November 2013.  Her work involves helping older people, their family, carers, and professionals to prevent and stop abuse.  Her presentation will include narratives that demonstrate the dilemmas of speaking out about abuse and the impact harm has on people’s lives.shutterstock_105457523

Adults suffer abuse when their human or civil rights are breached. The absolute human right ‘not to be tortured or treated in an inhuman or degrading way’ should be promoted by us all and be reflected in the quality of the services we provide.   It is Important that we enable people to have control over their own lives, treat them with dignity, support them to have the best physical and mental health possible, and facilitate their financial security. Continue reading

Making Health and Care Fit for an Ageing Population.

Kings Fund and BGS Conference: BGS President Elect, David Oliver, describes how this conference ties in to the work of the BGS and the Department of Health’s new proposals to improve care for vulnerable older people.
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On 22 October, the Kings Fund is hosting a one day event on making health and care services fit for an ageing population. This event is supported by the BGS and several of our members are speaking. I am fortunate to have a foot in both camps as BGS president-elect but also as a Kings Fund Visiting Fellow. We have timed the event to coincide with the planned autumn announcement by Rt Hon Jeremy Hunt MP – Secretary of State for Health – of the Vulnerable Older Peoples Plan. Mr Hunt is due to speak at our event and announce some further details. Continue reading

Old and still driving

A conference report from the BGS Spring Meeting in Belfast, by Liz Gill.

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One of the most negative images of older people concerns older drivers. Yet by any yardstick they are the safest group on the roads, as Prof Des O’Neill, consultant physician in geriatric and stroke medicine at Adelaide and Meath Hospital in Dublin, pointed out. There were issues though with increasing age and it was worth geriatricians getting involved with assessing someone’s fitness to drive. Continue reading

The social and economic contribution of our elders

A conference report from the BGS Spring Meeting in Belfast, by Liz Gill.

Another look at the future came from Claire Keating, commissioner for older people in Northern Ireland. “Shed loads of people are having increased longevity and that is a challenge but no-one becomes 80 overnight so it’s a case of planning. And current projections are not set in stone. For instance, we need to treat older people who have bowel cancer now but we also need to get their grandchildren to eat more vegetables so that there aren’t unacceptable levels when they get to that age.

“We get obsessed with money and the pessimistic outlook gets more attention. Yet the latest research shows that when you add up all economic and social contributions and all the taxes and voluntary work, older people make a net contribution to society of £40bn. Continue reading

European Courts and Old People

Graham Mulley is emeritus professor of elderly care, University of Leeds.

image by Gwenaël Piaser

image Gwenaël Piaser

The current issue of Age and Ageing features an original paper on Older Europeans and the European Court of Justice by Israel Doron.  Why should busy geriatricians be interested in legal activities in Europe?

The short answer is that these courts have the potential for championing old people’s human and legal rights.  These courts often judge in favour of elders, yet the number of cases referred is small and is not increasing – despite the greater numbers of elderly citizens. Continue reading

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. Continue reading

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. Continue reading