How do geriatricians improve outcomes after hip fracture?

Jenny Neuburger is a Senior Research Analyst at the Nuffield Trust  (@NuffieldTrust) and a Visiting Research Fellow at the London School of Hygiene & Tropical Medicine. She and her co-authors have recently published research in Age and Ageing journal.

hipWe have just published a paper showing that geriatrician involvement in hip fracture care can improve patient outcomes.  Patients treated on wards with higher numbers of geriatrician hours tended to have lower mortality within the 30 days after presentation.

We measured geriatrician hours worked in orthopaedic departments using data collected via the National Hip Fracture Database annual survey each year from 2010 to 2013 for English hospitals.  Over this period, geriatrician hours increased from 1.5 to 4.0 hours per patient, reflecting investments made in response the financial incentives introduced under the Best Practice Tariff scheme. Continue reading

The steps we are taking to reduce inpatient falls

Prof Finbarr Martin is a Consultant Geriatrician at Guy’s and St Thomas’ NHS Foundation Trust and Professor of Medical Gerontology at King’s College London. He is a former President of the British Geriatrics Society.

patient-falls-preventionHow good is your department and hospital at preventing your patients falling? About 600 inpatients fall every day. As clinicians, we are fully aware of the injuries that can result from older people falling in hospital and the serious effect a fall can have on their recovery. So what can we do to prevent this happening? NICE guidance suggests we can reduce the number of falls by up to a third. The issue is high on the national patient safety agenda, but we need to be able to gather reliable data to ascertain if greater awareness is leading to the falls rate reducing.

Last year, the London Royal College of Physicians carried out an audit of hospital policies and practice in falls prevention, producing a national picture and a report on each hospital in England and Wales. The audit items were based on guidance from NICE and NPSA. You can access the national report here. Please find the time to take a look at your hospital’s data. Continue reading

Catching older people before they fall – a simple intervention to help identify those at risk

Simon Thomas is an Honorary Fellow of the School of Pharmacy, Keele University and a Director at Prescribing Decision Support – a Keele University spin-out company that delivers knowledge-based e-media systems designed to support healthcare decision making. Most recently, Simon has worked with NICE and Boehringer Ingelheim Ltd on the development of an innovative anticoagulation therapy decision support tool that assists patients and doctors in shared decision-making. Simon can be contacted at s.thomas@keele.ac.uk

ToolkitFalls and fall-related injuries in older people is a high-risk, high-cost problem. Notwithstanding the considerable human impact – distress, pain, injury, loss of confidence, loss of independence and mortality – falls account for the largest number of emergency hospital admissions for older people in the UK and cost the NHS over £2 billion each year. Continue reading

Is there ever a case for shared rooms in hospitals?

aaJacqui 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?

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July issue of Age & Ageing now available

(This is a corrected version of a blog published last week) 

The July 2015 issue of Age and Ageing, the journal of the British Geriatrics Society is out now!

A full table of contents is available here, with editorials, research papers, reviews, short reports, case reports book reviews and more. Hot topics this issue include:

  • Pharmacotherapy for type 2 diabetes
  • Exercise regimens and bone health
  • Balance training for in-patient rehabilitations
  • What are frailty instruments for?
  • Oestrogen replacement in postmenopausal women

The Editor’s View can be read here.

This issue’s free access papers are:

Falling: is the heart to blame?

heartSofie Jansen is a research fellow at the department of Geriatric Medicine in the Academic Medical Center in Amsterdam, the Netherlands. Her PhD focusses on the contribution of cardiovascular diseases to falls in older adults. Last year she spent six months as a visiting researcher in Trinity College, Dublin. In 2015 she will start her training as a Medical & Geriatrics Registrar. In this blog she comments on her recent publication in Age and Ageing journal. 

People often consider falling to be an unavoidable consequence of old age – we’ve all heard stories of a grandmother or elderly aunt who has taken a tumble. As such, falls are often accepted as a fact of life by older persons and those who care for them. But is this really the case? There are a number of factors that individually, or in combination, can contribute to people falling: balance problems, poor vision, the side-effects of medication. Most of these factors can be treated or targeted, leading to a reduction in falls. Recognition of these treatable risk factors is therefore important.

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New research highlights unseen dangers of pelvic fracture

A new study published in Age & Ageing finds pelvic fracture mortality rates equivalent to those for hip fracture, despite lack of attention or funding.  shutterstock_53196796

The study into osteoporotic pelvic fractures in older patients has shown worrying effects on mortality, length of hospital stay and independent living.
It finds that mortality rates for pelvic fractures are comparable to those for hip fractures, but that the issue receives far less attention or funding. It calls for new guidelines and better management of pelvic fractures in older people, helping them to maintain an independent life.

Yousif Shanshal and Sheena Waters, co-authors of the report, said:

“Pelvic fracture patients incur a high cost to an already stretched NHS, with increased lengths of stay and high mortality rates. They are usually frail elderly patients with multiple comorbidities, and often don’t regain normal function after their injury.

Following the work of the National Hip Fracture Database and the Best Practice Tariff, care for hip fracture patients has improved across the country. We now need to do the same thing for pelvic fracture patients.

It’s crucial that these patients are cared for by a geriatrician, in close liaison with their orthopaedic colleagues, and that a multi-disciplinary team is fully involved in each patient’s recovery and discharge.”

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Good Vibrations: whole body vibration treatment

Falls are common in older people and are the direct cause of many osteoporotic fractures. There are limited treatments available to help frail older people who are at risk of falls. A study funded by the National Osteoporosis Society and the British Geriatrics Society on the potential benefits of whole body vibration for frail older people has now been published in Age and Ageing.shutterstock_83367871

The collaborative work between the University of Loughborough and Nottingham University Hospitals NHS Trust showed that older people attending a falls prevention programme are able to tolerate whole body vibration.

Patients were recruited at The Nottingham University Hospitals Rehabilitation Unit and all of them took part in the NICE recommended falls prevention programme, which includes exercise. They were split at random into three groups. One group used a vibration platform that moved vertically up and down; one used a vibration platform with a “see-saw” action and one group stood upon a stationary platform whilst a buzzing noise was played so that they thought they were receiving vibration (sham vibration). The vibration training involved visiting the unit three times per week over 12 weeks, and standing on the plate during several short bouts of vibration, for a maximum of 6 minutes in total. Continue reading

September issue of Age and Ageing journal out now

The September 2014 issue of Age and Ageing, the journal of the British Geriatrics Society is out now.

A full table of contents is available here, with editorials, research papers, reviews, short reports, case reports book reviews and more. Hot topics this issue include:

  • Vitamin D guidelines
  • Adverse effects of anticholinergic medicines
  • Interdisciplinary care and falls prevention
  • Measuring quality of life in care homes
  • Undergraduate education in geriatric medicine

The Editor’s View can be read here.

This issue’s free access papers are:

Research studies test if a new guide does reduce falls in care homes?

Gemma Walker is a Research Assistant at Nottingham University. She recently described the Falls in Care Homes study on the ENRICH website:

Falls in care home residents occur 5 times more frequently than those in older adults living in the community. ENRICH WebsiteMany of these people suffer injury and there are high associated costs to the NHS. A falls management programme that can reduce falls as well as current community programmes has yet to be established in care homes; possibly because current programmes are not tailored to the care home population, known to experience high levels of cognitive impairment.

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