How should healthcare services to care homes be configured – results from the Optimal Study

Adam Gordon is Clinical Associate Professor in Medicine of Older People at the University of Nottingham. He tweets @adamgordon1978 Claire Goodman is Professor of Health Care Research at the University of Hertfordshire.  She tweets @HDEMCOP Here they describe findings from the Optimal Study, funded by the National Institute of Health Research and delivered by a collaboration of researchers from the Universities of Hertfordshire, Nottingham, Surrey, City University London, University College London, Kings College London and Brunel University.

The UK care home sector, with 425,000 beds, is just over three times the size of the acute hospital sector.  It is home to some of the oldest and most vulnerable members of UK society.  The average resident is over 85, has multiple health conditions, cognitive impairment and physical dependency.  Providing care to such older adults is recognised to be complex and challenging.

Autumn Speakers Series: The boundary between health and social care

Adam Gordon is Clinical Associate Professor in Medicine of Older People at the University of Nottingham.  He is currently principal investigator for the Dunhill Medical Trust funded PEACH study which considers using quality improvement collaboratives to implement Comprehensive Geriatric Assessment in care homes.  His twitter handle is @adamgordon1978.  You can follow the PEACH study @PEACHstudy. He will be speaking at the upcoming BGS Autumn Meeting in London.

Care home residents in the UK receive their healthcare predominantly through the National Health Service. Their social care – primarily focussing on enablement to support activities of daily living and supporting participation in society – is provided by staff in their care home.

Or at least that’s how it looks on paper.  In reality, the boundary between health and social care is less well defined.  Providing care to the older people who live in care homes, many of whom have multiple conditions and are approaching the end of their life, requires frequent give and take between healthcare and care home staff.

‘Water, water everywhere’; dehydration in the older population

Janet Gordon & Marie Henson both work for Birmingham Community Healthcare NHS Foundation Trust. Janet Gordon is a dietitian working in Nutrition Support and is team leader for the adult Nutrition Support Team which is part of Birmingham Community Nutrition. At the time of the study Marie Henson was a Community Nurse team leader in the Kings Heath area of Birmingham, which is where the study took place. This study was presented as a poster at BAPEN Conference 2016 and was published here.

The prevalence of dehydration in older people in the UK has not been widely studied. The UK DRIE Study found 20% of residents in UK long term care were dehydrated. The prevalence in those living at home has not been determined. Dehydration in older people is linked to associated morbidities such as increased falls, confusion, and infections and is a frequent cause of hospitalisation. Clear signs of early dehydration in older people are yet to be determined, but there is a need to identify those at risk of dehydration and intervene early. Systems for recognising those with inadequate fluid intakes, and helping them to drink more, are already in place in many UK hospitals where a red jug scheme identifies those requiring assistance to drink.

A Warm Glow in Solihull

Maxine Burrows and Yvonne Obaidy are Collaborative Leads for Early Help 0 – 19 at Solihull Metropolitan Council.  They develop high quality sustainable services for children, young people and families.  In this blog they talk about a new intergenerational pilot that they are working on and how they are enjoying the challenges and diversity that this work is providing.  Dr Zoe Wyrko (Consultant Geriatrician. Associate Medical Director – Quality Development, University Hospitals Birmingham) is providing them with support and help as needed, including evaluation tools for the older adults. You can follow them at @EngageSolihull

We are carrying out a pilot of intergenerational working in Olton, a district of Solihull in the West Midlands, with two local partners – St Bernard’s Residential Care Home for older adults and Tender Years Day Nursery. The care home has lovely cosy rooms – which are not huge, and the nursery has transport for five children so we chose to do a small pilot involving just five older adults to start with. Our intergenerational activity takes place every Wednesday at 10.30am for one hour.

We had several preliminary individual meetings with the nursery and the care home and then all parties came together for a final planning meeting two weeks before the pilot started. The meetings were useful for clarifying roles and responsibilities and planning some of the activities.  Most importantly the final meeting enabled the care home staff and nursery staff to meet and share their reasons for taking part in the pilot.

September 2017 issue of Age and Ageing journal is out now

The September 2017 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 in this issue include:

The future of Comprehensive Geriatric Assessment

Causes of unsafe primary care

Improving medication adherence after hospital discharge

Oral health in hospitals and care homes

Research methods: how to do a systematic review

The Editor’s View article gives an overview of the issue with a summary of highlights. This article is free to read and can be viewed here.

Autumn Speakers Series: Under what circumstances, and in what ways, is a quality improvement collaborative likely to succeed in a care home setting?

Dr Reena Devi is a research fellow in the Division of Medical Sciences and Graduate Entry Medicine at the University of Nottingham. She is working on the PEACH (‘ProactivE heAlthcare for older people living in Care Homes) study, which is led by Dr Adam Gordon, and funded by the Dunhill Medical Trust. She will be speaking at the upcoming BGS Autumn Meeting in London. She tweets @_DrReenaDevi 

Improving healthcare services delivered to older people is high on the national agenda. Nationwide initiatives are currently focusing on this, for example, six of the Vanguard projects set up in response to the 5 year forward view are specifically devoted to delivering new models of healthcare into care homes. Smaller scale initiatives are also being carried out in local settings, such as the PEACH project.

The PEACH project is using improvement science to bridge the gap between what we know and what we do in terms of the healthcare services delivered to care homes in South Nottinghamshire. The project is working with 4 clinical commissioning groups and their associated healthcare and care home providers, and is focusing on bringing healthcare services closer in-line with the Comprehensive Geriatric Assessment (CGA) model of care.

The struggle for age-proof medical care in the Netherlands

Wilco Achterberg (1963) is an elderly care physician and a Professor of institutional care and elderly care medicine in Leiden, the Netherlands. His research focus is on the most vulnerable elderly, most of whom live in nursing homes, and is centered around two themes: pain in dementia and geriatric rehabilitation. He tweets @wilcoachterberg

The Netherlands have been very fortunate to have had a very good insurance system for long term care, which provided good funding for nursing home care. That is why in a typical Dutch Nursing home you can find, next to nurses, therapists like physiotherapists, occupational therapists, psychologists, dieticians and even physicians. In 1989, a 2 year post graduate medical training program started, and ‘nursing home physician’ became an officially recognised medical specialism.  The biggest challenge for Ageing Holland is not how to provide good care for older persons, but how to pay for that care. Therefore, for several years now government is trying to find other ways of caring for vulnerable and care dependent persons.

Reflections on ‘NOT Forgotten Lives: Felixstowe 2017’

Liz Charalambous is a nurse and PhD student. She tweets at @lizcharalambou and is a regular guest blogger for the BGS. Here she reviews ‘NOT Forgotten Lives: Felixstowe 2017’ edited by Julia Jones and Bertie Wheen

‘NOT Forgotten Lives’ is a written record, produced for the 2017 Felixstowe Book Festival, which celebrates the lives of older people living locally in residential accommodation. This slim volume is organised by an overview of what life story work is about, followed by photographs and accounts of the life stories of residents living in nursing and residential accommodation in Felixstowe. It concludes with a personal reflection from the co-editor, Bertie Wheen.

Why is this book important?

In a world where dementia is on the increase there are political, economic, ethical and often personal reasons why society must wake up to the reality of the disease. Currently an estimated 50 million people worldwide live with dementia, with a forecast of 131.5 million by 2050.  In the UK there are 850,000 people living with the disease, estimated to increase to 2 million by 2050. These figures alone suggest that dementia is a disease which can no longer be ignored.

Old People’s Home for 4 Year Olds

Dr Zoe Wyrko is a Consultant physician at University Hospital Birmingham and is the Director of Workforce for the BGS. In this blog she discusses the recent Channel 4 programme in which she appeared, Old People’s Home for 4 Year Olds. She tweets @geri_baby

I’ve always had a soft spot for care homes. As a child I would occasionally go into work with my Mum and meet some of the old ladies she talked about. When I was older I started work in the same nursing home as a kitchen girl on Saturdays, and then later progressed to health care assistant. I remain proud of my training record from that time, showing I am competent to deliver personal care, clean dentures and cut nails.

This is why I was excited when an approach came from CPL productions, who were looking for geriatricians to be involved with a television programme they wanted to make about introducing children to a care home environment.

What does good look like when thinking about care homes?

Claire Goodman is Professor of Health Care Research at University of Hertfordshire. Claire has a district nursing background and is a NIHR Senior Investigator. Her research focuses on the health and social care needs of the oldest old, including those affected by dementia and living in long term care. She leads the DEMCOM study, an evaluation of Dementia Friendly Communities – @DEMCOMstudy @HDEMCOP

We have new neighbours. They moved three miles to improve their children’s chances of going to their preferred secondary school. If they had stayed put they would have been assured of getting a good state education. We are surrounded by Ofsted rated ‘good’ and ‘outstanding’ schools. The issue was that whilst it probably did not matter if their daughter went to a girls only or co-educational school, for their son, a boys only school, with a big focus on sport, would have been a problem. People in my local area know a lot about the schools, they know what the head is like, who the good teachers are, what extra-curricular activities are available and if it’s struggling with its budget.