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. Continue reading
Frailty is now widely recognised as a key component of declining health and function in old age. Older people with urgent care needs are particularly likely to experience frailty. New acute illness can trigger the onset of frailty in an older person who, in whom the limits of their functional capacity may be urgently revealed. Older people are increasingly the main users of urgent care services. Accordingly, urgent care services for older people need to be able to recognise, evaluate and manage frailty. 
There have been many changes in recent years. The patients are older with more frailty, multiple comorbidities and a mixture of social and medical issues. These patients are often described as ‘complex’, making them sound as if they are something special. The reality is that they are now the norm and everybody should be able to deal with the norm. These problems are recognised by Royal College of Physicians in 
Nationally there is increasing recognition of the needs of frail older people in health systems, and the UK’s rapidly ageing population will only increase in the years to come.
Countries around the world are seeing significant growth in the numbers of people living longer and healthier lives. We all need to reflect proactively on how we can best maximise the intergenerational benefits this will undoubtedly bring and we must also address the challenges it will generate.
Fashions come and go, in clothing, news and even movie genres. Medicine, including geriatric medicine, is no exception. When I was a trainee, falls and syncope was the next big thing, pursued with huge enthusiasm by a few who became the many. But when does a well-meaning medical fashion become a potentially destructive fad? Frailty, quite rightly, has developed from something geriatricians and allied professionals always did to become a buzz word even neurosurgeons bandy about. No bad thing for all professionals who see older people to have awareness of the recognition and management of this vulnerable and resource intensive patient group. 
As practitioners and researchers in care of older people, it is important for us to be continually working to include more dependent groups in research. The reason for doing so is to ensure that the evidence base can reliably be applied to the patients we see in everyday practice. However involving older people with dependency in research can be challenging because cognitive and physical impairments can make standard procedures for recruitment and data collection difficult. 
We are used to the idea that CGA is effective. That still leaves us with a few problems. Who does CGA help? How does CGA help? What are the crucial elements that make it effective? Are wards better than teams and how can we be sure?
British Geriatrics Society 