The Geriatrics “Profanisaurus.” Volume 2 –  The diagnostic myths that do not die

Dan Thomas is an ST5 based in the Mersey Deanery (HENW) and is the Clinical Quality Representative on the BGS Trainees Council. He tweets @dan26wales

In 2013 Professor David Oliver wrote a blog, the Geriatrics “Profanisaurus”, a list of words and phrases that should be banned, he encouraged other ‘BGS-ers to join in the fun and add their own “unutterables”.

My contribution to this list is some frequently encountered diagnoses that should be approached with scepticism.

‘Bilateral cellulitis’: If both legs are infected then the person should be unwell. Usually red legs are caused by a combination of underlying pathology; acute lipodermatosclerosis, venous hypertension, venous stasis dermatitis, lymphoedema or panniculits. The legs are hot and swollen but in the context of someone who is afebrile with minimal inflammatory response. The reason they are not responding to antibiotics is because they do not have an infection. Continue reading

John’s Campaign: three years old, November 30th 2017 Changing the culture of care?

Nicci Gerrard and Julia Jones founded John’s Campaign after the publication, in the Observer newspaper on November 30th 2014, of Nicci’s article about the death of her father Dr John Gerrard. They tweet @JohnCampaign

John’s Campaign advocates for the removal of all restrictions on family carers supporting their relatives in hospital and a positive attitude of welcome and collaboration throughout the health and care system.  It places no duty on informal carers and imposes no specific procedures on professionals – other than making their welcome explicit. Dementia is a disability as well as an illness: access to this additional level of support (if available) should be a right for people living with dementia. Information, contacts and resources can be found on the John’s Campaign website www.johnscampaign.org.uk Continue reading

Book Review: Please tell me…

Liz Charalambous is a nurse and PhD student. She tweets @lizcharalambou and is a regular guest blogger for the BGS. Here she reviews ‘Please tell me…’ by Julia Jones and Claudia Myatt.

Without a doubt, one of the most important documents in older person care is the Alzheimer’s Society This is me support tool. It enables carers to access information with which to provide holistic care and is underpinned by a social model of care rather than a medical model, so important in today’s world of fast paced, pressurised, and increasingly politicised healthcare services. It places the person in the centre of care, ensuring their likes, dislikes, and preferences are recorded for the whole team to access.

Indeed, a favourite teaching strategy when introducing new students to dementia care is to provide them with two copies of ‘this is me’ and ask them to take them home for their partners or significant others to complete in the manner of ‘Mr and Mrs’ style 1970s TV programme. I have heard many stories of students returning the next day reporting back to the group that their other half had failed hopelessly in filling in the form, prompting them to realise the precariousness of ensuring person centred care in such instances. Continue reading

Antidementia medication may improve survival in Alzheimer’s disease

Dr Christoph Mueller is an Academic Clinical Lecturer at the Department of Old Age Psychiatry at King’s College London. He and his co-authors published a paper on the influence of antidementia medication on survival in Alzheimer’s disease in Age and Ageing. He tweets at @DrChrisMueller

At present Acetylcholinesterase inhibitors, as Donepezil or Rivastigmine, are the only medications available for treatment of the early stages of Alzheimer’s disease. They can slow down the progression of the illness and alleviate distressing symptoms. However, their benefits are modest and they can have side effects, such as a slow heartbeat, indigestion, weight loss or an increased risk of falls. Moreover, dementia and Alzheimer’s disease is the leading cause of death for men and women 80 years or older in England and Wales. We investigated whether being prescribed antidementia medication was associated with survival in patients with Alzheimer’s disease. Continue reading

Promoting Activity, Independence and Stability in Early Dementia (PrAISED)

Professor Rowan H Harwood is a geriatrician at Nottingham University Hospitals NHS Trust, and the University of Nottingham, with particular interests in delirium, dementia and end of life care, who maintains an active portfolio of research. He tweets @RowanHarwood 

Can exercise-based therapy prevent or delay disability and dependency in those in the early stages of dementia?

We have heard the drum beat of gloomy messages. We cannot continue to cope with ever greater demands for health and social care. Prevention is better than cure, but the NHS is ‘on the hook’ for failing to take prevention seriously.

There is a semblance of a response. Sustainability and Transformation Plans emphasise prevention. We know that some groups, such as people with frailty or dementia, are at risk of crises and functional decline, and on the cusp of dependency and need for services. It makes sense to identify people at risk earlier, and intervene. Continue reading

Dying with dementia – we need to measure more than the place of death

Katherine Sleeman is an NIHR Clinician Scientist and Honorary Consultant in Palliative Medicine at the Cicely Saunders Institute, King’s College London. In this blog she discusses her paper Predictors of emergency department attendance by people with dementia in their last year of life: Retrospective cohort study using linked clinical and administrative data. She tweets @kesleeman

Over the past decade there has been a strong policy focus in the UK and elsewhere on dying out of hospital as a marker of good quality of end of life care. We have previously shown that, for people with dementia, hospital deaths have fallen over this time period, possibly as a result of these policies.

However, it is increasingly recognised that the place of death is an imperfect proxy for the quality of end of life care, providing little more than a snap shot of where a person was in their last moments. Continue reading

Quality Dementia Care in Hospital Settings – It can be done!

Lynn Flannigan is an Allied Health Professional who is working as an Improvement Advisor for Focus on Dementia. She tweets @lynnflannigan1 Dr Graeme Hoyle is a Consultant Physician in the Department of Medicine for the Elderly in NHS Grampian. He tweets @AbdnGeriatrics.

Focus on Dementia, in partnership with Aberdeen Royal Infirmary, have produced a publication which explores the critical success factors which lead to improved outcomes for people with dementia, their carers and staff in acute care, which we would like to share with BGS members.

Focus on Dementia is a national improvement portfolio based within the ihub of Healthcare Improvement Scotland. We work in partnership with national organisations, health and social care practitioners, people with dementia and carers to reduce variation and improve quality of care. Continue reading

Always on my mind: Understanding the role of music in dementia

Sally Bowell is a Research Fellow at the International Longevity Centre – UK (ILC-UK). In this blog post she discusses a new Commission on Dementia and Music, set up and run by ILC-UK.

Music is an undeniably significant part of being human. It spans different genres, cultures and eras, and it promotes bonding, communication and wellbeing.

From listening to music in the car, to playing in an orchestra, discussing the charts, to joking about each other’s ‘bad’ music tastes: music is a crucial part of daily life.

Research also suggests that our connection to music stays with us throughout our lives, even whilst living with dementia. This powerful notion underpins the creation of a new Commission on Dementia and Music, being coordinated by the International Longevity Centre – UK (ILC-UK) and funded by the Utley Foundation. Continue reading

Reflections on ‘NOT Forgotten Lives: Felixstowe 2017’

Liz Charalambous is a nurse and PhD student. She tweets at @lizcharalambou and is a regular guest blogger for the BGS. Here she reviews ‘NOT Forgotten Lives: Felixstowe 2017’ edited by Julia Jones and Bertie Wheen

‘NOT Forgotten Lives’ is a written record, produced for the 2017 Felixstowe Book Festival, which celebrates the lives of older people living locally in residential accommodation. This slim volume is organised by an overview of what life story work is about, followed by photographs and accounts of the life stories of residents living in nursing and residential accommodation in Felixstowe. It concludes with a personal reflection from the co-editor, Bertie Wheen.

Why is this book important?

In a world where dementia is on the increase there are political, economic, ethical and often personal reasons why society must wake up to the reality of the disease. Currently an estimated 50 million people worldwide live with dementia, with a forecast of 131.5 million by 2050.  In the UK there are 850,000 people living with the disease, estimated to increase to 2 million by 2050. These figures alone suggest that dementia is a disease which can no longer be ignored. Continue reading

What does good look like when thinking about care homes?

Claire Goodman is Professor of Health Care Research at University of Hertfordshire. Claire has a district nursing background and is a NIHR Senior Investigator. Her research focuses on the health and social care needs of the oldest old, including those affected by dementia and living in long term care. She leads the DEMCOM study, an evaluation of Dementia Friendly Communities – @DEMCOMstudy @HDEMCOP

We have new neighbours. They moved three miles to improve their children’s chances of going to their preferred secondary school. If they had stayed put they would have been assured of getting a good state education. We are surrounded by Ofsted rated ‘good’ and ‘outstanding’ schools. The issue was that whilst it probably did not matter if their daughter went to a girls only or co-educational school, for their son, a boys only school, with a big focus on sport, would have been a problem. People in my local area know a lot about the schools, they know what the head is like, who the good teachers are, what extra-curricular activities are available and if it’s struggling with its budget. Continue reading