Take time to talk! The importance of an informant history

Adam Dyer is a Final Year Medical Student in Trinity College Dublin. Dr. Sean Kennelly (MB PhD FRCPI) is a Consultant Physician in Geriatric and Stroke Medicine in Tallaght Hospital (Dublin, Ireland) and a Clinical Senior Lecturer in Medical Gerontology at Trinity College Dublin (TCD). The following work was presented as a platform presentation at the 64th Irish Gerontological Society Meeting in Killarney, Ireland (October, 2016).

Imagine you’re seeing a consult or you’re on a post-take ward round. How often do we examine a patient and identify cognitive deficits, see that the CT brain scan report and the MMSE score are readily on hand, but then ask staff about the patient’s premorbid cognition and function and are met with blank expressions?

An important factor which complicates the presentation of older people to acute hospitals is the presence of impaired cognitive status (either in the form of dementia, delirium or both). Continue reading

Spring Speakers Series: Assessing memory and thinking in stroke – it’s confusing

Dr Terry Quinn (Joint Stroke Association / CSO Senior Clinical Lecturer) has a clinical and research interest in post stroke cognitive decline. Supported by a Stroke Association Priority Program Grant he is pursuing a portfolio of work themed around how to assess cognition and mood in the Acute Stroke Unit. Terry will be sharing some of the findings from this and other work at the BGS Spring Meeting in Newcastle as part of a themed session on dementia. Terry tweets about all things cognitive @DrTerryQuinn and in his role as Coordinating editor of the Cochrane Dementia Group @cochraneDCIG

Specialist societies, clinical guidelines and audit standards all encourage us to assess cognition when patients present with stroke. Intuitively this seems like a sensible idea. We know that patients fear problems with memory and thinking more than they fear physical disability and we know that cognitive problems are extremely common in the post stroke period. What is less clear is how we should assess cognition in stroke. Continue reading

Unchain me: how our approach to safety leads to harm

Professor Joseph Ibrahim is Head, Health Law and Ageing Research Unit at Monash University’s Department of Forensic Medicine and the Clinical Director of Geriatric, Rehabilitation and Palliative Care Medicine, at a large regional health service in Australia. Joseph has a keen interest in promoting better care for older people and edits the Communiqués printed educational material designed for health professionals to learn from cases investigated by the Coroners Court. Learn more about Joseph on his personal website.

Joseph and the team recently completed a landmark Australian study published in Age and Ageing, examining deaths due to physical restraint of people living in nursing homes. The study found that five deaths were recorded in nursing home residents due to physical restraint over the 13-year period. The median age of the residents who died was 83 years; all residents had impaired mobility and had restraints applied for falls prevention; four had diagnosed dementia. The mechanism of harm and cause of death were ascertained by a forensic pathologist following autopsy and in all cases, were formulated as ‘neck compression and entrapment by the restraints’. Continue reading

‘Five a day’ keep dementia away, say researchers

fruit-and-vegHaving at least 3 servings of vegetables and 2 servings of fruit daily might help prevent dementia in older adults according to a study published today in Age & Ageing, the scientific journal of the British Geriatrics Society.

The study, which was conducted by researchers at the Chinese University of Hong Kong, followed the cognitive status of 17,700 dementia-free older adults for 6 years. The objective was to investigate whether those consuming at least 3 servings of vegetables and 2 servings of fruits daily, in line with the World Health Organisation recommendation, were at a lower risk of developing dementia. Continue reading

Frequent sauna bathing protects men against dementia

Jari Laukkanen is a professor at the University of Eastern Finland. He and his co-authors have recently published a research paper in Age and Ageing journal on the link between sauna bathing and memory diseases. You can follow him on twitter @LaukkanenJari

saunaFrequent sauna bathing can reduce the risk of dementia, according to a 20-year follow-up study.  Men taking a sauna 4–7 times a week were 66% less likely to be diagnosed with dementia than those taking a sauna once a week. The association between sauna bathing and dementia risk has not been previously investigated.

The effects of sauna bathing on the risk of Alzheimer’s disease and other forms of dementia were studied in the Kuopio Ischemic Heart Disease Risk Factor Study (KIHD), involving more than 2,000 middle-aged men living in the eastern part of Finland. Continue reading

Cause of death? Dementia…

Professor Emma Reynish is a consultant physician in Geriatric Medicine at Edinburgh Royal Infirmary, and Professor of Dementia Research, at the University of Stirling where she leads the dementia and social gerontology research group.

dementiaIn England and Wales more people now die of dementia and/or Alzheimer’s disease than anything else. A similar picture is most likely to exist for the other devolved nations of the UK. For healthcare professionals who are involved in the management of people with dementia, this news offers the opportunity for reflection and action. What does this mean for us and our approach to the older population? Continue reading

Only half of people with dementia get annual medical review

Claudia Cooper is an honorary consultant old age psychiatrist with Camden and Islington NHS Foundation Trust. She focuses on research related to dementia and mental health in older age. Here she discusses her recent Age & Ageing paper Inequalities in receipt of mental and physical healthcare in people with dementia in the UK.

Age&Aging front cover design chosen chosenPeople with dementia experience more mental and physical health problems than people without dementia, and more frequently take medication for mental health problems, so ensuring the get fair access to mental and physical healthcare is important.

Our study looked at primary care records of 68, 061 people with dementia and 259,337 people without dementia between 2002 and 2013. We looked at how rates of mental health medication prescribing (antipsychotic, antidepressant and sedative drugs);  contact with General Practice surgeries and physical health checks  (blood pressure, weight monitoring and an annual review) varied between people living in more and less deprived areas, and between men and women. Continue reading

East Midlands Dementia Day 2016

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 attended the East Midlands Dementia Day on 6 December 2016. She tweets at @lizcharalambou and is a regular guest blogger for the BGS. Opinions expressed in this blog are solely Liz’s own and do not express the views or opinions of her employer or any other organisation. 

major-oak-sherwood-forestThe East Midlands Dementia Day on 6 December 2016 at Nottingham City Hospital proved to be an inspiring and informative event. Organised by dementia specialists, Professor Rowan Harwood and Dr. Karen Harrison-Dening, the day welcomed expert speakers from Nottingham and further afield.

The day began with Professor Rowan Harwood  who presented an overview of dementia and its increasing importance from a public health and societal perspective. Painting the picture of the reality of dementia with stark statistics of multiple comorbidities; dementia in care homes and in hospital; and the reality of carer and family support for people with the disease, stressed the urgent need for further research. Continue reading

Hypertension and dementia: exploring the evidence

Jenni Harrison is a Clinical Research Fellow at The University of Edinburgh. Her previous role was as an Academic Clinical Fellow in Geriatric Medicine in Leicester. She was part of the Hypertension in Dementia (HIND) Research Group at the Universities of Nottingham and Leicester. The group recently produced a New Horizons article on the management of hypertension in people with dementia. She tweets @JenniKHarrison.

deerIn the face of uncertainty around the optimal management of hypertension in people with dementia we sought to review and summarise the available evidence. After first considering the rationale for the treatment of hypertension and possible reasons why the approach could be different for those with dementia, we structured our review around three key questions:

(1) Do people with dementia experience greater adverse effects from antihypertensive medications?

(2) Is cognitive function protected or worsened by controlling blood pressure?

(3) Are there subgroups of people with dementia for whom antihypertensive therapy is more likely to be harmful? Continue reading

Patients don’t just have dementia

Beverley Marriott is Birmingham Community Healthcare Foundation Trust Nurse Practitioner – Community Matron based at Heart of England Good Hope Hospital. She is currently undertaking a Fellowship in Older People at Kings College London. Here she reminds us that we need to see the whole person when looking at someone with dementia.

medical-pillsMany of us work within dementia care on a daily basis. As a community matron on an AMU department supporting safe and timely discharges for patients with dementia, I understand the importance of getting it right and what happens when we get it wrong.

Dementia has reached a critical point – over recent years the government has seen improvements in diagnosis, raising public awareness and promoting dementia friendly settings. However to deliver this level of improvement requires, time, resources and focus.  Continue reading