Help The Aged

Dr Sean Ninan is a registrar in Geriatric and General (Internal) Medicine in the Yorkshire Deanery. He tweets at @sean9n and @gerisreg . 

Here Sean writes on his blog, Senior Moments, about the importance of empathy in caring for older people.

Help The Aged.

I can see it everywhere.

In the patient list for the admissions unit – “acopia.”

In the nurse’s voice “Can you give her some lorazepam please?”

In the junior doctor’s tone “Another one admitted with falls. Nothing wrong with them.”

In the referral letter – “This lady has no (insert your own specialty here) -ological issues. Please could you take over her care”

Some healthcare workers do not enjoy dealing with older people. Part of me can understand why. It’s hard. Frail older patients place a lot of demands on staff. They need help washing and dressing. They need help with eating. They need help going to the toilet. They call out. They call out again. About the same thing you just reassured them about. And they don’t tell you what’s wrong with them. They come in “off legs” or confused, the same presentation hiding a multitude of diagnoses – from constipation to cord compression.

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

PANICOA – the Prevention of Abuse and Neglect in the Institutional Care of Older Adults

Laura Izzard is an Specialty Trainee in Geriatric Medicine at Kings College Hospital, London

PANICOA – the Prevention of Abuse and Neglect in the Institutional Care of Older Adults – is a joint research initiative between Comic Relief and the Department of Health.

Published in December 2013, the PANICOA report ‘Respect and Protect’ draws together the findings of eleven individual research studies commissioned to examine the complex issue of mistreatment of older people in hospitals and care homes. It outlines three vantage points i.e. “narratives” reflecting the perspectives of residents and patients, care staff and care organisations. Themes emerging from the PANICOA Narratives were used by the authors to produce a number of recommendations intended to reinforce and/or improve current practice.

Significant rise in older people living and being diagnosed with HIV

A new paper published online today in Age and Ageing argues that despite a year-on-year increase in the number of people over the age of 50 being diagnosed with the Human Immunodeficiency Virus (HIV), there is a reluctance of healthcare professionals to offer HIV tests to older people. This results in high rates of “late presentation” and therefore significantly increased mortality.

According to the article by Dr Eva Bunting and colleagues, of the Royal Sussex County Hospital, the proportion of older patients in the UK living with HIV has increased significantly. They quote the most recent Public Health England data, which shows that of an estimated 73,660 people living with HIV, in 2002 12% (3,640) were over 50 years old, while in 2011 that figure rose to 22% (16,550). In Brighton, where Professor Martin Fisher is based, this figure is as high as 35%.

There have been dramatic developments in HIV management since the introduction of combination antiretroviral therapy (cART) in 1996, but as the population of older people living with HIV increases, new challenges continue to emerge.

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?”. 

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.

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.

Old and still driving

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

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.

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.

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.