Improving Continence Care for Older People

Vikky Morris is Chair of the BGS Bladder and bowels Special Interest Group. She will be speaking at the upcoming event Improving Continence Care in Older People on 21 September in Manchester.

1 in 3 women and 1 in 7 men over the age of 65 experience urinary incontinence. It is a significant problem associated with falls, fractures, social isolation, depression, urinary tract infections and moisture lesions. Faecal incontinence affects up to 10% of the population, although its prevalence is much higher in older people, nursing home residents (up to 60%), patients with cognitive impairment and neurological conditions. Numbers are also likely to be an underestimate due to the stigma attached to incontinence. Both urinary and faecal incontinence are associated with great expense, both personal and to the NHS (more than 2% of the NHS budget). In addition, in older people, incontinence is second only to dementia as a reason for admission to a residential or nursing home. Continue reading

We need to talk about loneliness

Dr Shibley Rahman is an academic physician interested mainly in dementia and frailty. He tweets at @dr_shibley

This was my first ever BGS conference, just down the road from me, at the Wellcome Collection, London. The day was spent discussing ‘Loneliness in older people and its impact on health’ chaired by Professor Tahir Masud (@TashMasud), President-Elect of the British Geriatrics Society.

In a recent paper by Utz and colleagues (2014), the following is offered:

The term loneliness is often equated with social isolation or social participation. However, seminal work attempted to distinguish loneliness from these constructs by defining it as the cognitive or psychological appraisal of social relationships and activities. For example, loneliness has been conceptualized as the lack of “meaningful” social relationships or “incongruence” between actual and desired levels of social interaction.” Continue reading

Identifying older patients with frailty from routinely collected hospital data

Dr Thomas Gilbert is a consultant geriatrician (Hospices Civils de Lyon, FRANCE), with interests in Health Services Research. He worked with Dr Jenny Neuburger and colleagues from the Nuffield Trust in London on the development of the Hospital Frailty Risk Score whilst he was a clinical research fellow under the mentorship of Prof. Simon Conroy in Leicester (Department of Health Sciences).  He will be speaking at the Urgent care for frail older people event on 25 May at Horizon in Leeds. 

Advances in health care have helped people in developed countries live longer than ever before. This is good news for all of us, but it also presents a challenge to our health systems and a need to rethink the way that we provide healthcare. Out of nearly 20 million people admitted to an NHS hospital in the UK in 2015, a quarter were aged 75 years or older, and this proportion is set to increase.

For some older people, hospitalisation is associated with increased harms over and above their presenting clinical condition. Recognising that age alone is insufficient to identify and respond to such vulnerability, the term ‘frailty’ is increasingly being employed to highlight patients exposed to an increased risk of poor outcomes and likely to require higher resource use. Continue reading

Using population sub-segmentation to promote tailored end of life care in later life

Professor Martin Vernon is National Clinical Director for Older People and Person Centred Integrated Care at NHS England. He tweets @runnermandoc. Dr Dawn Moody is Associate National Clinical Director for Older People and Integrated Person-Centred Care for NHS England. She tweets @Moody_D_K. They will be speaking at the BGS Living and Dying Well with Frailty event today. Follow the conference via #bgsconf

Frailty is an especially problematic long term condition characterised by declining intrinsic capacity to deal with stressor events such as acute illness or physical accidents. When severe it significantly increases personal annual risk of reaching end of life. While occurring alongside human ageing, not everyone develops frailty and it is not solely confined to older people. NHS England estimates 20% of the population aged 90 and over remains fit and are therefore likely to be fortunate in ageing well. Conversely we estimate that up to 25% of people aged 65 to 69 are living with mild frailty in England which compared to their fit peer group places them at twice the annual risk of reaching end of life.  A further 5% of this age group is estimated to be living with moderate or severe frailty. Continue reading

Spring Speakers Series: Are rules of thumb the answer?

Nathan Davies is a Senior Research Fellow at University College London focusing on care for people with dementia towards the end of life and supporting family carers. In this post he talks about his upcoming talk at the BGS Spring Meeting in Nottingham on his work developing rules of thumb for providing care towards the end of life for someone with dementia.

Can rules of thumb help manage uncertainty and the challenges facing practitioners caring for someone with dementia at the end of life?

We know that caring for someone towards the end of life can be a rewarding and intimate experience with that individual and those close to them. However, unfortunately for practitioners it can also be emotionally tough and challenging. This is particularly the case when caring for someone with dementia towards the end of life. Continue reading

Practical palliative care after stroke

Dr Ruth England is a Consultant in Palliative Medicine at Royal Derby Hospital. She tweets @DrRuthEngland. She will be speaking at the upcoming BGS event Living and Dying Well with Frailty on 6 March in London. Please note this event has now SOLD OUT.

Palliative care is an active, holistic approach to those facing life-threatening illness. Good palliative care allows us ‘to live as well as possible for as long as possible’; and includes support for those approaching the end of their life.

In the UK, someone suffers a stroke every 5 minutes. Although there has been a decline in stroke mortality, it remains a leading cause of death in those aged over 65.  There a high risk of dying immediately after an event, and 40% of those affected by stroke die within a year. Long term survivors are likely to be burdened with ongoing physical, psychological and social issues. Continue reading

How was your BGS Autumn Meeting 2017?

David Scott is a 78 year old retiree from Teacher Education with type 2 diabetes and heart failure. In retirement he has developed a strong interest in patient engagement issues. These are engaged with via the Alzheimer’s Society, NiHR (specialist group on Ageing) Age UK and the Stem Cell Bank. He attended the BGS Autumn Meeting 2017 as a patient representative. Register for the BGS Spring Meeting, 11 – 13 April at NCC in Nottingham.

How was your BGS Autumn Meeting 2017? I enjoyed meeting a lot of people with plenty of experience and don’t the Geriatricians look young these days!  Remember that I am 78 years plus. What about that location? Very intimidating on first arrival but once in your allocated space, superb facilities. Plenty of toilets, plenty of overall space, good catering – with alternative if you didn’t mind going a bit further. Found the steps down between levels quite hard but recognise the need to do your daily exercise!  One or two smaller rooms got a bit crowded for some presentations but, in general, presentations well supported. Continue reading

Is this your first time?

Dawne Garrett is Professional Lead for Older People and Dementia at the Royal College of Nursing (RCN) Eleanor Sherwen is Professional Lead for Palliative and End of Life Care, and also works at the RCN. They will be delivering a workshop at Living and Dying Well with Frailty Meeting on 6 March in London. Please note this meeting has now sold out and there will be no on site registration. To join the waiting list please email registrations@bgs.org.uk

Approaching end of life care discussions with the patient for the first time…

Dawne and I have been asked to deliver a 60 minute workshop on this key and sometimes challenging area of practice. The importance of choice and the delivery of holistic person centred care is repeatedly highlighted in the literature, both from researchers and policy makers.  Yet how can we even begin to deliver person centred care when there is at times a reluctance to open up and initiate these essential conversations? Let alone when communicating with someone who has limited sight, poor hearing and cognitive impairment. The evidence says that professionals can feel more comfortable approaching conversations in relation to sex, rather than having conversions with patients and those that are important to them focused on death and dying.  Continue reading

Inaugural BGS Eastern Region Geriatric SpR Research & Audit Presentation Day

Katie Honney obtained her MBBS BSc (Hons) at University College London. She completed her foundation and core training in the eastern deanery and is currently working at the Queen Elizabeth Hospital, King’s Lynn, as a specialty registrar in geriatric medicine.

cambridgeOn the 24th June 2016 the inaugural BGS Eastern Region Geriatric SpR Research & Audit Presentation Day took place at NAPP Pharmaceuticals, Cambridge Science Park. The wealth of excellent research and audit work conducted by trainees within the region prompted the need for an opportunity in which this work could be shared among colleagues.

The day commenced with an informative presentation from Prof John Potter relating to blood pressure control and cognitive function. Prof. Potter told the audience about the rising prevalence of hypertension with age, as well as discussing how cognitive impairment is associated with the extremes of blood pressure. Continue reading