Jacqui Close is a consultant in Orthogeriatrics at the Prince of Wales Hospital in Sydney, Director of the Falls and Injury Prevention Group at Neuroscience Research Australia and President of the Australian and New Zealand Society for Geriatric Medicine. Her research interests range from injury epidemiology, to intervention studies and implementation research.
The days of the Nightingale ward are thankfully gone. No longer do we see two long neat rows of beds with starched sheets. Whilst the occupants of the bed were rarely encouraged to roam freely, the close proximity of the beds allowed for easy spread of highly mobile viruses and bacteria. Even in the absence of an understanding of infection risk, many complained about the lack of dignity and privacy resulting from this ward design.
Time has moved on and there is recognition of the multiple benefits of single rooms for all patients including older people. Single rooms allow for the delivery of health care which minimizes infection risk, respects privacy, promotes dignity and on the whole reflects with wishes of those people unfortunate enough to require a period in hospital. But is a single room right for everyone and can we be flexible in the way we deliver care?
In the patient list for the admissions unit – “acopia.”
In the nurse’s voice “Can you give her some lorazepam please?”
In the junior doctor’s tone “Another one admitted with falls. Nothing wrong with them.”
In the referral letter – “This lady has no (insert your own specialty here) -ological issues. Please could you take over her care”
Some healthcare workers do not enjoy dealing with older people. Part of me can understand why. It’s hard. Frail older patients place a lot of demands on staff. They need help washing and dressing. They need help with eating. They need help going to the toilet. They call out. They call out again. About the same thing you just reassured them about. And they don’t tell you what’s wrong with them. They come in “off legs” or confused, the same presentation hiding a multitude of diagnoses – from constipation to cord compression.
Urinary incontinence, the condition in which people wet themselves by accident, is a common problem for older people. Around half of older people have “bladder trouble” such as needing to rush or get up lots of times overnight to pee, and up to one in six will have accidents.
Despite this, many people view these bladder problems as a normal part of ageing (they aren’t), or as something that can’t be treated (they can). Continue reading →
Gillian Fox, Alison Cracknell, Sadia Ismail and Eileen Burns are all Consultants in Interface Geriatrics at Leeds Teaching Hospitals NHS Trust
Leeds Teaching Hospitals has a 60 bedded general adult medical admissions unit and a 60 bedded Elderly Admissions Unit with comprehensive geriatric assessment (CGA) embedded to either facilitate discharge to community services with ongoing assessment and/or rehabilitation where needed or begin treatment and investigation before transfer to an elderly care ward.
As part of the Leeds acute care model, 2012 saw the introduction of Interface Geriatricians (IGs). This service was developed with initial funding from the PCT (later CCGs) aiming to avoid admission where appropriate. We have developed a model for working for the IG that covers 3 key areas of interface – community, PCAL (primary care access line) and the emergency department (ED). Continue reading →
Iain Wilkinson is an ST6 in the London Deanery and wrote the letter below for publication in the BGS newsletter
The second Francis report into the failings at Mid Staffordshire hospital will have stirred up feelings in a number of the readers of this newsletter. For me, I am actually quite anxious about the report. I see a number of things that happened at North Staffs that happen in every hospital I have worked in. The report shines a spotlight onto a number of areas of our practice as geriatricians and on-call general medical doctors, as highlighted by David Oliver’s excellent review (March 2013). Much of this is “structural” in nature (i.e.. training etc.). There are however some areas that are key to the way we work. Continue reading →
“All patients were by legal definition vulnerable, but older patients who might be confused, frightened and without family were even more so and any doctor who ignored that would be condoning institutional abuse.”
The hard hitting message was delivered to the BGS’s Spring Meeting by guest lecturer Robert Francis QC, chairman of the Mid Staffordshire inquiry, who told us: “We know that most of the issues were nursing ones but medical leadership is the key to solving them. All doctors should be in a position to take the lead.”
Doctors in Mid Staffordshire had failed to intervene for a variety of reasons including a sense of disengagement, a reluctance to rock the boat or make a fuss, fears about discretionary payments or pensions. The result was a catalogue of horror stories, some of which he described to his audience to whom he issued a plea, “Remember these stories and don’t ever fall into those categories. The future is in your hands.” Continue reading →
As Geriatricians I strongly feel one of our most important roles is providing Palliative Care in the acute hospital and within other settings such as nursing homes. We only have one opportunity to get this right and getting it wrong can cause lasting, irreparable damage to those left behind.
As a terminally ill cancer patient, diagnosed at the age of 29 with a rare and aggressive sarcoma, these aspects of care have been brought into even sharper focus. Death is not an abstract concept for me; it is a reality in my foreseeable future. For the moment, though, I remain well enough to work part-time as a Specialist Registrar in Geriatrics. Continue reading →
Professor Justine Schneider is Professor of Mental Health and Social Care at the University of Nottingham, UK. She writes here about an inspirational project which used research outputs to develop a play providing unique insights into dementia care.
Inside Out of Mind is an innovative theatre project which has brought together ethnographic researchers with arts practitioners to tackle the challenge of dementia care. The resulting play brilliantly illustrates the multiple realities of life on a dementia ward, and is an inspiring collaboration between Meeting Ground Theatre Company, Lakeside Arts Centre, The University of Nottingham’s Institute of Mental Health and the NHS.
Inside Out of Mind is based on field notes kept during months of participant observation in dementia wards by researchers Simon Bailey, Kezia Scales and Joanne Lloyd. Writer and Director Tanya Myers used the highly detailed and extensive notes as a “seed” to inspire this play about the largely mysterious world of inpatient dementia care.
Following the Francis Report we ought to be taking every opportunity to highlight excellence and quality in Health Care of Older People being delivered across many NHS trusts. This article from the Daily Mail reports an innovative scheme from Nottingham. It is an example of the sort of thing we ought to celebrate. Click on the hyperlink above – I’ll let the article speak for itself.
An inquiry into the quality of healthcare support for older people in care homes: a call for leadership, partnership and improvement.
This BGS report marks the start of a process of partnership to develop impetus, resources and clinical guidance that will support the NHS to play part in improving the experience and the quality of life of residents in care homes.
Its recommendations were developed collaboratively with stakeholders drawn from care homes, social care, NHS (including primary care) and academia.
The report describes current NHS support for care homes. It tells a story of unmet need, unacceptable variation and often poor quality of care provided by the NHS to the estimated 400,000 older people resident in UK care homes. It describes what should and could be done and calls for national action by government and local action by NHS commissioners, planners and clinical services to improve the quality of NHS support to care homes.
It highlights the need to build joint professional leadership from the health, social, and care home sectors, statutory regulators and patient advocacy groups to find the solutions that none of these can achieve alone.