July 2018 issue of Age and Ageing journal is out now

The July 2018 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:

• Blood pressure targets in treatment of hypertension
• Falls prevention
• Probiotics and prevention of infection
• Improving healthcare outcomes in care homes
• Caregiver relationships and Parkinson’s disease

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.

May 2018 issue of Age and Ageing journal is out now

The May 2018 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:

• New pain assessment guideline
• Future population burden of
  multimorbidity
• Systemic anti-cancer treatment for
  older people
• Treating malnutrition in care homes
• Effects of different types of
  exercise in older people
• Research methods – diagnostic test
  accuracy studies

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.

New clinical guidelines in Age and Ageing journal

David Stott is Professor of Geriatric Medicine at the Institute of Cardiovascular and Medical Sciences at the University of Glasgow and is Editor in Chief for Age and Ageing journal. 

Clinical guidelines are intended to help health care practitioners adopt best practice. Good guidelines have the potential to reduce variations to practice and improve patient outcomes while ensuring efficient use of health-care resources.

There are however a plethora of guidelines, often with contradictory advice and of variable quality.

Importantly, for care of older people, guidelines have often lacked relevance due to restricted focus on single-organ disease, ignoring the realities of frailty with multi-morbidity, cognitive impairment (acute and chronic) and disability. However this is gradually changing, and guidelines now are emerging that are directly relevant for care of frail older people.

Given the increasing importance of guidelines in clinical decision making, this year Age and Ageing has added clinical guidelines as a new category of article. The journal is now publishing both ‘stand-alone’ guidelines (3000 words) and commentaries (1500 words). Already two papers have been published; the best practice guidelines for the management of frailty by Turner and Clegg give advice on the management of frailty in community and outpatient settings. The summary of the National Osteoporosis Society Vitamin D guideline by Aspray et. al. charts a rational approach to the confusing topic of when to measure 25-hydroxy vitamin D, and when and how to treat. I am keen to encourage further submissions of high-quality guideline articles to Age and Ageing.

Must clinical guidelines be followed for all patients? Obviously not! Here we can follow the logic of Margaret Thatcher (Scott Enquiry) who said ‘…Guidelines are for the guidance of officials to be consistent. Of course they have to be followed, but they are not strict law. That is why they are Guidelines and not law and, of course, they have to be applied according to the relevant circumstances.’ Therefore guidelines should be seen as important in informing practice but not in dictating it.

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)

The Science of Frailty

Dr. Roman Romero-Ortuno (@rrorthy7) is a newly appointed Consultant Geriatrician at Addenbrooke’s Hospital, Cambridge. In this blog, he outlines the scientific underpinnings of frailty and how this emerging science will lead to greater personalisation of treatments.

Frailty is vulnerability to decompensation after a stressor event and is a consequence of cumulative decline in many physiological systems during a lifetime.

Campbell & Buchner defined frailty as ‘a condition or syndrome which results from a multi-system reduction in reserve capacity to the extent that a number of physiological systems are close to, or past, the threshold of symptomatic clinical failure; and as a consequence the frail person is at increased risk of disability and death from minor external stresses’.

Fit for Frailty

Dr Gill Turner is Vice President – Clinical Quality for the BGS and project lead for Fit for Frailty –  guidance published today on the recognition and management of older patients with frailty in community and outpatient settings. 

Frailty, or the ‘F’ word, must score as the most talked about condition over this last year. It is hard to go to any scientific meeting, participate in any discussion about health service development or even read a newspaper without encountering the  ‘ F ‘ word.

But what does it mean?  It is likely that frailty means different things to each audience ranging from a scientific phenotype with specific outcomes in the Framingham heart study to a social description of someone in the last months of their life.

However, the real meaning of frailty for the NHS and social care is the possibility of identifying a group of older people, for whom services need to be specifically focused to improve quality and safety. The expectation is that through increasing effectiveness in proactive care, increasing efficiency and value for money will follow.

The British Geriatrics Society which represents more than 2700 UK specialists in health care for older people (doctors, nurses and allied health professionals) has produced  Best Practice Guidance for Frailty in community and outpatient settings. Under the title ‘Fit for Frailty’, it is published in 2 parts. Part 1, launched today describes the recognition and management of individuals with frailty in community and outpatient settings. Part 2 to be launched later in the summer, will describe the development, management and commissioning of services for people with frailty.

Frail Fail: Four Thoughts on Framing Frailty Teaching

James Fisher is an St5 in Geriatric and General Internal Medicine currently working at Northumbria Healthcare NHS Foundation Trust. He has an interest in medical education, is the co-founder of the Association of Elderly Medicine Education (aeme.org.uk) and tweets at @drjimbofish.

I remember as a medical student attaching myself to a ward round with a busy senior physician. We had just reviewed a patient, an elderly lady, who had been chatting away happily to the consultant. The clinical details of the case have long since faded from my memory but I do vividly recall that as we walked away from the bedside, the clinician said to me: “Well, unfortunately she is clearly dying”. This hit me like a train. The idea that the patient I had just seen, who seemed so full of life, was dying, had never even entered my head.

Atrial Fibrillation: The real story behind the new NICE guidelines

Richard Bogle is a Consultant Cardiologist based in London and Surrey. He specialises in the assessment and treatment of patients with all types of heart and vascular disease. He tweets at @richardbogle

If you watched the news this week you might have thought that the only recommendation in the NICE Atrial Fibrillation Guideline was that doctors should not prescribe aspirin to prevent strokes. In fact most cardiologists and geriatricians stopped using aspirin for this condition several years ago and the NICE recommendation simply reaffirms those issued previously by other professional societies such as the European Society of Cardiology.

The real story behind the guidelines was, in my opinion, nothing to do with medication or rate versus rhythm but rather the importance of delivering a personalised package of care for patients with atrial fibrillation (AF). Recognising that AF is a long term health condition there is emphasis on the importance of shared decision making processes particularly around anticoagulation. Alongside the guideline NICE published a Patient Decision Aid to assist with this process. 

The F word

Dr Gill Turner is Vice President – Clinical Quality for the BGS and project lead for Fit for Frailty –  guidance published today on the recognition and management of older patients with frailty in community and outpatient settings. 

Frailty, or the ‘F’ word, must score as the most talked about condition over this last year. It is hard to go to any scientific meeting, participate in any discussion about health service development or even read a newspaper without encountering the  ‘ F ‘ word.

But what does it mean?  It is likely that frailty means different things to each audience ranging from a scientific phenotype with specific outcomes in the Framingham heart study to a social description of someone in the last months of their life.

However, the real meaning of frailty for the NHS and social care is the possibility of identifying a group of older people, for whom services need to be specifically focused to improve quality and safety. The expectation is that through increasing effectiveness in proactive care, increasing efficiency and value for money will follow.

The British Geriatrics Society which represents more than 2700 UK specialists in health care for older people (doctors, nurses and allied health professionals) has produced  Best Practice Guidance for Frailty in community and outpatient settings. Under the title ‘Fit for Frailty’, it is published in 2 parts. Part 1, launched today describes the recognition and management of individuals with frailty in community and outpatient settings. Part 2 to be launched later in the summer, will describe the development, management and commissioning of services for people with frailty.

Review of the iPhone app for Delirium and Dementia

Dr Sutha Yoganathan reviews the new iPhone app: Confusion: Delirium and Dementia

App type: A mix of E-learning/ Clinical Bedside.

Platform and Costs: Apple, Free

Target Audience: Junior Doctors, GPs, Allied health Professionals, Medical Students, Hospital Doctors

Test Drive: The delirium and dementia app is one of the few clinical apps that have been designed with the UK-NHS inspired approach towards managing the confused patient. Based upon the latest NICE guidelines of their respective subject matter, the app makes a decent stab at tackling what many junior doctors find to be a tricky issue.