The struggle for age-proof medical care in the Netherlands

Wilco Achterberg (1963) is an elderly care physician and a Professor of institutional care and elderly care medicine in Leiden, the Netherlands. His research focus is on the most vulnerable elderly, most of whom live in nursing homes, and is centered around two themes: pain in dementia and geriatric rehabilitation. He tweets @wilcoachterberg

The Netherlands have been very fortunate to have had a very good insurance system for long term care, which provided good funding for nursing home care. That is why in a typical Dutch Nursing home you can find, next to nurses, therapists like physiotherapists, occupational therapists, psychologists, dieticians and even physicians. In 1989, a 2 year post graduate medical training program started, and ‘nursing home physician’ became an officially recognised medical specialism.  The biggest challenge for Ageing Holland is not how to provide good care for older persons, but how to pay for that care. Therefore, for several years now government is trying to find other ways of caring for vulnerable and care dependent persons. Continue reading

MAPLE-V: Taking a collateral history for cognition

Rebecca Winter is an Elderly Medicine registrar; she is currently taking a year out of programme as a Clinical Education Fellow at Brighton and Sussex Medical School (BSMS). Twitter: @rebeccawinter27

Muna Al-Jawad is an Elderly medicine consultant at the Royal Sussex County Hospital, Brighton. She works on a mixed acute medical and mental health ward.

mapleIt’s a familiar scenario, you are on your Elderly Medicine placement and you are asked: “Can you get collateral history about Mrs Smith´s cognition?” You don´t want to miss anything, but what exactly do they want to know?

Dementia is an increasingly common and important condition. In the UK, at least one quarter of acute hospital beds are occupied by patient with dementia, with admissions spread across a broad range of specialties. (1) Despite this, the UK National Dementia Strategy (2) has highlighted deficiencies in behaviour and skills of healthcare professionals caring for people with dementia. Continue reading

‘A journey of a thousand miles begins with a single step’: raising the status of care home nursing

Dr Miriam Stanyon is a Research Fellow on the Achieving Quality and Effectiveness for Dementia Using Crisis Teams (AQUEDUCT) research programme at the University of Nottingham. She also worked, until very recently, for a number of years as a care assistant in care homes.  Here she talks about work to establish agreed competencies for Registered Nurses working in care homes.

nursing-home-residentIt is no secret that care home nurses get a bad press. If you type ‘care home’ into the BBC news website, the result is a series of stories about neglect and elder abuse, care homes put in special measures by the CQC or having to close due to lack of funding.  Among nurses themselves, care home nursing has a lower status than working in the NHS. It has traditionally been seen as a job to do when you’re close to retirement or can’t get a job in a hospital. I remember speaking to a colleague after she had attended some CPD training (which she had to self-fund and attend in her own time) and she expressed how she felt embarrassed to ‘only work in a care home’. Continue reading

Start With Why

Dr Sean Ninan is a registrar in Geriatric and General (Internal) Medicine in the Yorkshire Deanery. He tweets at @sean9n and @gerisreg shutterstock_114405178

Here Sean writes on his blogs, Senior Moments, about why he has chosen to specialise in geriatric medicine, and how he wants to inspire junior doctors as they begin their rotation in his department.

Start With Why.

Welcome to the older people’s ward. My name is Dr Sean Ninan.

I hope you enjoy your time on the ward. You will certainly learn lots. By the end of your time here you will see patients with classic geriatric syndromes, sepsis, malignancy, acute kidney injury, neurological disorders and much more. We will teach you to become very good at assessing patients with delirium, falls, blackouts, immobility, Parkinson’s disease, dementia as well as general medicine topics like sepsis, acute kidney injury and acute coronary syndromes. You will learn what frailty really means and what it means to perform comprehensive geriatric assessment. I expect you to learn about these topics because you will be looking after patients with these problems, but wherever possible, we will try to tailor learning to your chosen career, whether that is general medicine or general practice. If you are going to be a surgeon, obstetrician or something else, then bear with us! It is still important that you learn about geriatric medicine in order to provide a good quality of service, and hopefully you will still enjoy it, and take some of what you have learned into your future career. I also hope that we can convince some of you along the way to join us in geriatric medicine in the future.

Continue reading

Be the Master of Your Own Destiny (with a little help from the BGS!)

Dr Sarah White

In my fourth year as a medical registrar I was feeling disheartened with gruelling on-calls, never ending night shifts and the constant daily battle and bureaucracy on the wards.  I decided to undertake a masters degree to re-awaken my passion for learning and medicine.  I opted to do the Gerontology Masters at King’s College, London.

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Several friends had undertaken part time MSc’s and all had bemoaned the difficulty of balancing a full time job and on-call commitments with essay writing, examinations and lengthy dissertations.  As one part-time masters friend put it, she did “just enough to get by”, which greatly reduced her masters experience.  I wanted to the get the most out of my masters and give it my full attention hence decided to do it full time over one year.  However, the major downside of being a full time student is lack of income!  Masters fees are expensive (mine cost £6,500), regular travel to university from outside London was not cheap; printing and photocopying costs were an unexpected and substantial outgoing; not to mention the ever increasing cost of living.  Needless to say I relied on personal savings, sporadic locum shifts and a very understanding fiancé to support me through the year.

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Geriatric Medicine and the burden of common sense.

Prof Kenneth Rockwood is Director of Geriatric Medicine Research at Dalhousie University, Canada and serves on the International Advisory Panel of Age and Ageing journal. shutterstock_145815530

I’ve been teaching geriatric medicine for about 25 years. During that time, my attitude towards the common sense of geriatric medicine has changed. At first, I saw it as a great blessing: it was easy to let people know what they needed to do. Then I began to see it as a challenge: an audience could sit through a diverting 40 minutes, but in the end not be persuaded that they have learned anything. “Nothing to that – it’s all common sense”. Now I see the common sense of what we do as a foe, and one that we should conquer. Continue reading

Shape of Training Report – more clarity needed before the opportunities can be realised

CGAandFHCZoe Wyrko is a Consultant physician at University Hospital Birmingham and is the Director of Workforce for the BGS. She tweets at @geri_baby

A joint position statement has been released by the Royal Colleges of Physicians (Edinburgh, Glasgow and London), and JRCPTB on the Shape of Training report (ShOT). Since the publication of Professor Greenaway’s report late last year there has been a considerable amount of concern that the recommendations contained within would lead to the decimation of postgraduate medical training in the UK, resulting in a sub-consultant level and inadequately trained doctors. I previously blogged about this in November 2013.

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Unfit for purpose?: UK Undergraduate Medical Training is not teaching doctors enough about ageing

Adam Gordon and Adrian Blundell are Consultants and Honorary Associate Professors in Medicine of Older People at Nottingham University Hospitals NHS Trust. They write here about a programme of work to better understand how UK medical schools teach about ageing, undertaken on behalf of the British Geriatrics Society.shutterstock_136378154

Let’s not beat around the bush here. Older patients make up the lion’s share of work for the National Health Service – as they do for the health services of all developed, and many developing, economies. Most doctors currently in practice will spend the bulk of their career dealing with older patients. Many of those older patients will have frailty, or physical dependency, or multiple medical conditions. Many will have all three. Continue reading

Twenty (One) Tips for junior doctors working with older people

Dr Sean Ninan is a registrar in Geriatric and General (Internal) Medicine in the Yorkshire Deanery.

This week on his blog, Senior Moments, he shares Twenty (One) Tips for junior doctors working with older people.

  1. Be good to older people. Many of your patients will be frail and vulnerable. Much of society may view them as a burden. You should not. These are mothers, fathers, husbands and wives. They have been on this planet two or three times as long as you have and many of them will have rich tales to tell. It is your job to look after them as well as you can, with empathy and kindness.

  2. Be part of the team. Physiotherapists, occupational therapists, other allied health professionals and experienced nurses will know things that you don’t know – both day to day information, and nuggets of clinical wisdom. Introduce yourself to them, ask about progress, and feed back relevant information. You are now working in a multidisciplinary team.

  3. Older people are really complicated. Acute coronary syndrome (to give just one example) will rarely be treated in a standardised fashion on an elderly ward. Some patients may be suitable for all the drugs on an ‘ACS protocol’. Others may not be suitable for more than one (or even none). Far more will be in between. Look at what your seniors are doing, and ask them why. Remember there is very little black and white in geriatric medicine and different doctors may do different things. Think about their reasoning and decide what kind of doctor you will be.

Read the full article on Sean’s blog here.

Getting out of our box – subspecialty training in Community Geriatrics

Jenny Thain is a Specialty Trainee and Wei Mei Chua is a recently appointed consultant in Geriatric Medicine.  Jenny is based in Nottingham and Wei in Derby, UK.  Both took part in a newly designed Specialty Training Rotation in Geriatric Medicine at Nottingham University Hospitals in 2012-2013. Here they share their experienceshutterstock_99252104

In August 2012 we were privileged to take up the first dedicated specialty training post in Community Geriatrics in the UK. We were, at that time, two less-than-full-time trainees in the East Midlands region, and both of us were in the latter stages of our training. Over the years we had participated in the odd community session, such as domiciliary visits and community hospital ward rounds. But it was only when we took up this post – which lasted a year – that we discovered the extensive nature of the sub-specialty and what it had to offer. Continue reading