10 days in a hospital bed leads to 10 years’ worth of lost muscle mass in people over age 80

Dan Thomas is an ST6 working in Liverpool. He is the BGS Clinical Quality Group Trainee Rep and the Deputy Media Editor. He tweets @dan26wales

‘10 days in a hospital bed leads to 10 years’ worth of lost muscle mass in people over age 80’

I have lost count of the number of times I have quoted this fact, I use it when teaching on frailty, and I have used it when assessing people in the emergency department to explain the risks of hospital induced deconditioning. I regularly hear other Geriatricians use this fact. It is emblazoned across much of the #EndPJParalysis material, and is quoted (unreferenced) on the NHS improvement website.

When low blood pressure is too low in old age

Sven Streit is a general practitioner at the Institute of Primary Health Care (BIHAM) in Bern (CH) and PhD Candidate at Leiden University Medical Center (NL). In this blog, he introduces the results of his PhD in a recent Age & Ageing paper on blood pressure, mortality risk and cognitive decline in a population-based cohort of oldest-old (all 85 years) in Leiden. He tweets @Sven_Streit

With increasing age, blood pressure rises as a consequence of arterial stiffness. It has been debated whether or not to it is beneficial to treat hypertension in old age, especially in >75-year-olds when they have multimorbidity, polypharmacy or frailty. Large hypertension trials showed that lowering blood pressure in over 60-year-olds is beneficial and lowers the risk for myocardial infarction, stroke and all-cause mortality, even in >80-year-olds. However, these trials lack generalizability and typically excluded patients with multimorbidity and frailty. At the same time, observational studies raise concerns about lowering blood pressure too much, since there are several cohort studies showing a reverse association between low blood pressure and increased mortality and accelerated cognitive decline starting from age >75-year-olds.

Frequent drinkers unravelled

Beth Bareham, NIHR SPCR  doctoral fellow at Newcastle University Institute of Health and Society and Institute for Ageing (@bkateb1) She co-authored the Age and Ageing Paper Drinking in later life: a systematic review and thematic synthesis of qualitative studies exploring older people’s perceptions and experiences with Professor Eileen Kaner @EileenKaner, Liam Spencer @LiamPSpencer and Professor Barbara Hanratty @BarbaraHanratty.

Within the United Kingdom, older people experience more alcohol-related hospitalisations and deaths than any other age group. Risky drinking amongst  older people is not just confined to the United Kingdom. Potentially harmful patterns of drinking are common amongst older age groups across the globe. Older people are not only at risk because they drink more often, but also because quantities of alcohol that may have been safer earlier in life have the potential to damage an older person’s health if, like most, they have medical conditions or take medications. However, moderate drinking in older age has been linked with some health benefits, and drinking may also have a positive impact on their social lives. The impact of alcohol on older people is complex, and many different factors can influence their choices. To modify riskier drinking in later life and support people to live longer, healthier lives, it’s vital that we understand these complexities. 

MY heart leaps up…

John Starr, Professor of Health & Ageing, Director of the Alzheimer Scotland Dementia Research Centre, University of Edinburgh.

I have been a consultant geriatrician in Edinburgh for over twenty years. I studied in Cambridge and London, and worked in Kent, the West Midlands and London before moving to Scotland.

Recently, one of my PhD students had just got a post-doc post. He’s a mathematician by training and we’ve been working on applying graph theory to EEGs to understand changing connections in the brain before the onset of dementia. He’s shortly going on to work with the Dementia Research Institute, including the vast genomic data of UK BioBank. He has no background in biology so I was explaining to him how all our cells have the same DNA, but not all the genes are expressed by all cells.

Comprehensive Care – NIHR themed review of research into older people with frailty in hospitals

John Gladman is Professor of the Medicine of Older People, Division of Rehabilitation and Ageing and Honorary Consultant in Health Care of Older People at Nottingham University Hospitals NHS Trust.

Vast sums are spent on research into the care of older people, but they are wasted if the findings are not put into practice.

I had an epiphany a few years ago. I looked at my carefully curated curriculum vitae, and noted that I had over 100 peer reviewed papers to my name. But I suddenly felt deflated when I realised that hardly anybody (apart from the journals’ editors) had ever read them. Deflation was followed by shame as I realised that I had made no effort to disseminate my findings to those who might find them useful, or to encourage the application of the findings in practice. I recovered a bit when I realised that it wasn’t just me. There is a real problem as the amount of research being published is monstrously huge. But I returned to shame again when I thought about how little effort I have taken to ensure that I keep up to date with other people’s research.

Systematic reviews for studies of older people

Susan Shenkin is Associate Editor for Systematic Reviews at Age and Ageing journal. She has recently published Systematic reviews: guidance relevant for studies of older people. She tweets at @SusanShenkin

Systematic reviews and meta-analyses are increasingly common. Our recent article in Age and Ageing journal aims to provide guidance for people conducting systematic reviews relevant to the healthcare of older people. It’s essential that systematic reviews are performed by a team which includes the required technical and clinical expertise: if you’re planning to do a review, ask for advice and support early. We hope that highlighting these issues will also help people reading systematic reviews to determine whether the results will influence their clinical practice. Here is a summary of ‘good practice points’.

Who’s our jolly good Fellow?

The Editorial Board of Age and Ageing is delighted to announce the launch of a Fellowship attached to the Age and Ageing Journal.

This opportunity is intended for trainees who plan a career in geriatric medicine who are interested in medical publishing. The 2-year appointment will run concurrently with the Fellow’s usual clinical post (or during period out of programme for research).

The Fellow will learn about manuscript preparation, peer review, manuscript editing, and journal production.

Roles will include involvement in general Journal business including handling submissions (under the supervision of the Editor or Associate Editor).

Clinical academia: the enigmatic puzzle

Liz Charalambous is a qualified nurse on a female, acute medical HCOP (Health Care for Older People) ward at Queen’s Medical Centre, Nottingham University Hospital Trust. She tweets at @lizcharalambou and is a regular guest blogger for the BGS.

Six months into a PhD to research the concept of volunteers in dementia and acute hospital wards, it has become apparent to me that there are a number of ways this area can be explored. Should I do a case study and examine the directorate as a whole? Or would ethnography be better to allow me an understanding of the organisational culture? Maybe a phenomenology study to understand the lived experience of those involved? How about a biographical account of a volunteer or maybe grounded theory to discover emerging theory?

Help develop research relevant to older people

Helen Roberts is Associate Professor of Geriatric Medicine at the University of Southampton and the national lead for the National Institute for Health Research (NIHR) Comprehensive Research Network Ageing Speciality Research Group.

The National Institute for Health Research (NIHR) is now 10 years old! During the last decade it has contributed significantly to the health and wealth of the nation and is now the most comprehensive research system in the world. The Ageing Speciality Research Group is part of the Comprehensive Research Network funded by NIHR and has a remit to increase participation in research into ageing within the NHS. This means encouraging more clinical staff and older people to take part in more studies.

Flourishing ageing research

James Goodbrand is the Ageing research group administrator 

Formed in 2009, the Age and Ageing Specialty Group is part of the National Institute for Health Research (NIHR) Clinical Research Network which provides the infrastructure that allows high-quality clinical research to take place in the NHS. It is dedicated to improving the lives of older people by building the profile, quality and activity of UK ageing research by engaging with funders, Age UK, older people and other active and potentially active researchers.