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.

How additional diagnostic tools add to the clinical dementia diagnosis

Anouk Meijs did her internship in epidemiology at the department of Geriatric medicine of the Radboud University Medical Center and is now working as an epidemiologist at the National Institute of Public Health and the Environment in the Netherlands. She has recently been published in Age and Ageing journal.

Although Alzheimer’s disease makes up the bulk of dementia diagnoses, many other forms of dementia exist as well. Establishing the correct dementia diagnosis is important for treatment but can be difficult. Therefore, we use additional diagnostic tests such as brain scans and lumbar punctures, but it is not really known what benefits these tests – that always come with costs and patient burden – have to offer in daily practice.

Calling all geriatricians… FRAILsafe needs you!!

Zoe Wyrko is pleased to announce the next phase of FRAILsafe, a new checklist for the acute care of frail older people.

Would you like to be involved in a national project which will change the way care is delivered to all frail older people, not just those who are able to be looked after by geriatricians on our specialist wards? Would you like to be part of work that will lead to improvements in the skills of all healthcare professionals who encounter vulnerable people in hospital? Would you like to see a reduction in the inadvertent harm caused when a frail older person needs to be admitted to hospital? If so …. read on.

The Red Flag tool for diagnosing Motor Neurone Disease

Jennifer Bedford of the Motor Neurone Disease Association announces their new tool, Red Flag, for supporting GPs to diagnose Motor Neurone Disease. 

Motor neurone disease (MND) is a devastating progressive degenerative disease of the motor neurones. Whilst it is rare, with a prevalence of 5-7 per 100,000, GPs can expect to see 1-2 cases in their career; and thus  important that awareness of it is raised.

Getting On? Growing Older With Autism

Anna Boehm, Policy and Parliamentary Officer for the National Autistic Society writes about a new report Getting On? which highlights the need to improve autism diagnosis rates amongst older people.

Say the word “autism” and most people will picture a child. But of course this child will grow up and, eventually, reach older age. The particular challenges facing people with autism at this stage in life are the subject of the National Autistic Society’s new report, Getting On? Growing older with autism.

All older people admitted to hospital must be assessed for memory function

Professor Emma Reynish, Chair of the British Geriatrics Society Dementia and Similar Disorders Section comments in response to the findings of the second National Dementia Audit.

It is good to see that some progress has been made in improving hospital based dementia care since the last audit.   It is vital that all older people admitted to hospital receive an assessment of their memory function as part of a holistic evaluation of their needs so that they can be managed and treated appropriately.  The evidence shows that when frail older people are admitted to hospital they are 25% more likely to be alive and living independently at home when they are looked after in a specialist unit for older people which provides comprehensive assessment of their needs from the outset of their stay.

Early Diagnosis of Dementia

Dr Simon Wright is Consultant Psychiatrist for Older People at Rotherham Doncaster and South Humber NHS Foundation Trust and mamber of the BGS Dementia and related disorders special interest group

The issue of the early diagnosis of dementia, although not new, has recently been highlighted by the National dementia CQUIN for the screening for cognitive disorders in patients admitted to acute care, which commenced in 2012.

Other initiatives including a new NHS Call to Action, “The Right Care” has highlighted the need for acute hospital to be more “dementia aware and friendly”,  given the problems associated for caring for somebody with dementia in an acute setting. including delayed discharge and increased re-admission rates. A similar CQUIN programme is to be started in primary care from April 2013.