Louise Allan is a Geriatrician with a specialist interest in the Neurology and Psychiatry of Old Age. Her research interests include the non-Alzheimer’s dementias and the physical health of people with dementia. She will be speaking at the upcoming BGS Spring Meeting in Nottingham.
Between 47-90% of people with dementia (PWD) fall at least once a year (almost ten times more often than controls). After a fall, PWD are less likely to recover well, more likely to be hospitalised, are hospitalised for longer and are more likely to require increased care. We currently know little about the care received by these patients. There is evidence to suggest that staff may perceive PWD as less capable of rehabilitation and staff in community services providing follow-up care may not have specific training in the care of PWD. Continue reading →
Steve Parry works in acute medicine and older people’s medicine. He has a special interest in investigation and treatment of falls and blackouts in adult patients of all ages. He is BGS Vice President – Academic and Research.
Since those heady days in the late 90s when our local falls service was started by Rose Anne Kenny, falls services have moved from novelty to mainstream in the UK’s care of older people landscape. But has this service ubiquity made a difference?
Probably. Possibly. Or perhaps not. It’s almost impossible to say. Falls are notoriously poorly recorded and coded, though falls surrogates like hip fracture, the tip of the falls iceberg, provide at least a hard outcome measure universally recorded. Here, however, despite a decade and a half of falls and bone health services, the news is not good. Continue reading →
It’s the overwhelming feelings of regret and loss that get me. Every time. Whenever I hear a family member say they ‘can only wonder what might have been’ or a patient talking about what they can no longer do.
Whenever I see our Rehab Matters film I know that the fictional story it depicts is playing out in real life, behind closed doors, in homes across the country. It cuts deeply, as a physiotherapist, to hear these stories of how a lack of access to rehabilitation has changed a life.
It makes me burn at the injustice of so many people missing out. Because I know how access to high-quality rehabilitation can change a life for the better – how it can return a person to the things they love, and to the things they do with the people they love. How it can restore independence and a sense of self-worth. How it can restore a life; how it can save a life. Continue reading →
Dr. Susan Freter is an Associate Professor of Medicine at Dalhousie University, and a staff geriatrician at the Nova Scotia Health Authority in Halifax, Canada. She has a special interest in delirium prevention and management in orthopaedic patients.
Geriatricians talk a lot about post-operative delirium. It is common after surgeries, especially in people with a lot of risk factors (or we could say, especially in the presence of frailty), and even with recovery it makes for a bad experience. The occurrence of hip fracture, which mostly befalls patients who are older and frail, demonstrates this routinely. We know that taking extra care with at-risk patients can help to prevent delirium. Taking extra care can manifest in different forms: educating the caregivers, paying attention to hydration (is the patient actually drinking the cup of water that is plonked down in front of them?), paying attention to constipation (preferably before a week has gone by), making sure hearing aids are in the ears, and using medication doses that are geared for frailty, rather than for strapping 20 year olds. But how can what we talk about be translated into what we do? Does the ‘doing’ actually work in practice? Continue reading →
Shelagh O’Riordan is a consultant geriatrician and the clinical lead for the National Audit of Inpatient Falls. She was an acute hospital geriatrician in Canterbury in Kent for 14 years but moved in September 2016 to work Kent Community Foundation Trust as a community geriatrician. She developed and runs East Kent Falls and Osteoporosis service. She tweets at @jupiterhouse1
As the clinical lead for the National Audit of Inpatient Falls (NAIF) I have been involved in the development of some new tools to standardise fall prevention in hospitals and they are being launched this month. The first of these was launched on 13/01/17 and is on the measurement of lying and standing blood pressure.
One of the results we found in the last audit round (data collected May 2015) was that on average only 16% of patients over 65y in an acute hospital after 48 hours had had a lying and standing BP recorded! I found this to be a fairly shockingly low number. I’m known, like many geriatricians, to be a bit obsessed with measuring lying and standing BP. Continue reading →
Debra Eagles is a Resident in Emergency Medicine at The Ottawa Hospital in Canada. Here she discusses her recent Age & Ageing paper.
Your medical student reviews a case with you. It is a 78 year old woman who presents with right knee pain subsequent to a recent fall. The student has taken a comprehensive falls history and physical examination. After reviewing the knee x-ray, the student summarizes the case by stating the patient suffered a mechanical fall, luckily without evidence of fracture and can be discharged home. But wait, you say, can she safely mobilize? The medical student smiles triumphantly, yes, she was able to use her walker to ambulate a short distance. Excellent, you say, she can be discharged home. But you wonder, is there anything further you can do to determine what her risk of negative outcomes associated with falling is. Continue reading →
Spencer Winch is a specialist paramedic in urgent care and a trainee advanced clinical practitioner in emergency care. He has a special interest in falls and care of the frail older patient and his time is currently split between the ambulance service, the local emergency department and a masters degree in advanced clinical practice. @spencerlwinch
Anna Puddy, Kate Ellis, Gill Carlill, Josie Caffrey, Claire Wiggett and Moyra Pugh are all advanced hospital based occupational therapists specialising in emergency, acute and elderly care. @TheRealAnnaPud, @OTMoyra, @CaffreyJosie
With falls in patients over the age of 65 making up 8.5% of the emergency workload locally, paramedics and the ambulance service have found themselves in a prime position to assess, treat and discharge this cohort of patients pre-hospitally. This upholds Keogh’s vision that care and treatment should be delivered closer to home without the need for hospital, and is being achieved by ambulance crews on a daily basis as highlighted in a consultant paramedic colleague’s (NWAmb_Duncan – link to BGS blog) recent blog. Higher education and degree based programmes for the paramedic profession now encourage more thorough assessment of injury and illness and thoughts around causative factors of falls, length of lie and potential for acute kidney injury. Those that are discharged on scene are then flagged to the community falls prevention teams for mobility, functionality and care assessment provided by nurse and therapists. With increasing demand on all NHS healthcare agencies, these assessments are not instantaneous and literature would suggest that those who have fallen, are likely to fall again within 24 hours without immediate intervention. Continue reading →
Much akin to Charles Dickens’ famous tale of two cities, the orthopaedic bastille has been stormed with the publications of the Blue book and BOAST 1 guidelines. Supported by heavy artillery in the form of the new HRG tariff for hip fractures, the revolution has well and truly begun. Ortho-geriatric services across UK have been transformed and this has catapulted this emerging sub-speciality onto the map. As a trainee, the changes have been marked, radical and at times near miraculous. Orthopaedic junior doctors are actually taking time to document AMTS scores (Abbreviated Mini-Mental Test Score) in the admission clerk-in whilst Ortho-geriatricians are culturing a knack of looking at post-op wounds and prescribing post-op venous thrombo-prophylaxis. Continue reading →