Cognitive impairment, mortality and discharge from an acute hospital

Carole Fogg is a Senior Lecturer at the University of Portsmouth/Portsmouth Hospitals Trust, (UK). She is a PhD Fellow under the Wessex Collaboration for Leadership in Applied Healthcare and Research, exploring hospital care and outcomes for patients with cognitive impairment and dementia. Her paper “The relationship between cognitive impairment, mortality and discharge characteristics in a large cohort of older adults with unscheduled admissions to an acute hospital: a retrospective observational study has recently been published in Age and Ageing. She tweets at @Carole_Fogg 

When older people with dementia are admitted to hospital, they are more likely to die or to stay in hospital longer than people without dementia. Many older people have cognitive impairment (CI) (problems with memory and thinking) which is a main feature of dementia, but have not yet been given a diagnosis, or may have CI due to other medical conditions. We investigated how common cognitive impairment is in older patients in hospital, and what the risks are for these patients of staying longer or dying in hospital. Continue reading

A life-course perspective necessary to improve the health of older adults

Dorota Chapko is a PhD candidate in Public Health at the University of Aberdeen in Scotland, and a graduate from the Massachusetts Institute of Technology (MIT) with a double-major in Brain & Cognitive Sciences and in Anthropology. In this blog she discusses her recent Age & Ageing paper on the triad of impairment; she tweets at @dorotachapko

aaAlthough frailty is a central concept in clinical assessment of older people, there is no consensus definition. The concept is certainly multifactorial but physical components dominate. However, it is known that age-associated physical decline is likely to be accompanied by cognitive and emotional deficits. The ‘triad of impairment’ (triad) recognises the co-occurrence of cognitive, emotional and physical deficits in late-life and might be a useful alternative to ‘frailty’.

Identification of pathways to prolong healthy living and decrease the degree of frailty in old age will have benefits for individuals and society. Continue reading

Report from the BGS Falls and Postural Stability Meeting 2015

BGS Logo CMYKThis year’s well attended Falls and Postural Stability Conference was held in Wembley, London. BGS member Mary Ni Lochlainn reports back.

The first session at this year’s BGS Falls and Postural Stability Conference was opened by Professor Alice Nieuwbower, from University of Leuven, Belgium, who discussed falls in the context of Parkinson’s Disease (PD).

Patients with PD are twice as likely to fall, compared to healthy older adults. It seems wobbling is a major factor here with ‘sway’ more predictive of falls than ‘gait speed’ in this population. Sway-metrics (probably not as much fun as they sound) show increased sway in patients taking levodopa, leading to a therapeutic challenge for clinicians.

Continue reading

When simple is no longer simple

Lawla Law has recently published her paper Effects of functional tasks exercise on older adults with cognitive impairment at risk of Alzheimer’s disease: a randomised controlled trial in Age and Ageing journal. This week she described the findings of the trial on the OUP blog:

Cognitive impairment is a common problem in older adults, and one which increases in prevalence with age with or without the presence of pathology. Brain AgingPersons with mild cognitive impairment (MCI) have difficulties in daily functioning, especially in complex everyday tasks that rely heavily on memory and reasoning. This imposes a potential impact on the safety and quality of life of the person with MCI as well as increasing the burden on the care-giver and overall society. Individuals with MCI are at high risk of progressing to Alzheimer’s diseases (AD) and other dementias, with a reported conversion rate of up to 60-100% in 5-10 years. These signify the need to identify effective interventions to delay or even revert the disease progression in populations with MCI.

Continue reading

March issue of Age and Ageing journal out now

The March 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:

  • Sensor technology and falls
  • Postgraduate training in dementia
  • Gender, frailty and life expectancy
  • Secular changes in alcohol consumption
  • Music-based exercise and cognition

The Editor’s Overview can be read here.

This issue’s free access papers are:

 

A specialist medical and mental health unit

Dr Rowan Harwood is‎ a consultant physician, professor of geriatric medicine at Nottingham University Hospital NHS Trust

There is a lot of criticism of how we manage cognitively impaired patients in acute hospitals. And advice on how to do it better. The hope has been that more expert and co-ordinated services would improve outcomes and save resources. But there has been little in the way of rigorous evaluation.

We developed a specialist medical and mental health unit with the ambitious objective of demonstrating best practice. We enhanced the ward environment, ward staffing and skill mix, including mental health specialist nurses, therapists and psychiatry, trained all staff to a high level in the person centred philosophy of care, and endeavoured to engage family carers more fully.

After 18 months of operation we ran a randomised controlled trial, published in the BMJ. This video abstract describes the intervention and trial results.To illustrate the challenges and capture the essence of compassionate person-centred care, we made a 23 minute documentary, called Today is Monday. Footage from this is used to illustrate the abstract.

The full 23-minute film is available for training purposes; interested readers are welcome to discuss this with me Rowan.Harwood@nuh.nhs.uk.