Framing the narrative of frailty differently will help to promote wellbeing

Dr Shibley Rahman is currently an academic physician in dementia and frailty. His contribution on the diagnosis of behavioural frontal frontotemporal dementia, published while he was a M.B./Ph.D. student at Cambridge in 1999, is considered widely to be an important contribution to the field even cited in the Oxford Textbook of Medicine. He has a passionate interest in rights-based approaches which he accrued as part of his postgraduate legal training. He tweets at @dr_shibley.

It’s great that frailty as a ‘brand’ is getting so much publicity, but is it all the right kind of publicity? For example, “Our treatment of the frail elderly is a national scandal”, Sunday Express, 8 March 2011. (cited in Manthorpe and Iliffe, 2015)

But some of the copy has been to generate a “moral panic”, defined as a feeling of fear spread among a large number of people that some evil threatens the well-being of society. Continue reading

A call for collaboration…

Cassandra Leese is a Nurse, Clinical Supervisor and a wannabe dog owner.  She occasionally remembers to tweet @contrarylass

In today’s economic climate, when health and social care are really feeling the crunch, I often find myself feeling morose about the future. Day after day we see the terrible pressures our overstretched services are under, read about the heartbreaking death of another promising doctor burnt out from battling it out in secondary care; or hear about another valuable service making drastic cuts. And selfishly, I’m rather cross that all this seems to have come at a time when I’m incredibly excited to have finally found my place in the nursing landscape, that of gerontology and geriatrics. Coming along to my first BGS West Midlands meeting this spring was a welcome reprieve from the madness spewed daily by the tabloids and renewed my faith that the good guys are still out there! Continue reading

Back to the Future? Please, no more studies “in the elderly”!

Shane O’Hanlon is a geriatrician and digital media editor for the British Geriatrics Society. He tweets @drohanlon Zoe Wyrko is a geriatrician and workforce lead for the British Geriatrics Society. She tweets @geri_baby

Sometime back in the 80s, when we were both nippers, Marty McFly got the chance to travel 30 years into the future and see how the world would change. Around this time in the medical literature it became common to take an interesting concept and tag “in the elderly” onto the end of it. Back then, we had articles on burns, epilepsy, even blunt chest trauma “in the elderly”. It was generally accepted that once you hit 65, *everything* changed. Suddenly you would be most unlikely to have surgery, palliation became the default, and you were fairly much on your way out. Because, after all, while nobody would ever dream of grouping neonates up to 40 year olds (the age we have just reached) into one group, surely it is acceptable to assume everyone from 65-105 is identical? Continue reading

“Frailty is the most problematic expression of population ageing”

Dr Diarmuid O’Shea is a Consultant Geriatrician at St Vincent’s University Hospital in Dublin, Ireland.  The aim of this article is to provide an overview of the clinical syndrome of frailty, how it can be considered and effectively managed as a long-term condition.

One of the greatest challenges posed by an ageing population is the ability of healthcare professionals to understand, recognise and manage vulnerable older adults at increased risk of adverse healthcare outcomes. This frailty syndrome is age associated and is most marked in among those over 75 years of age. The older person showing signs of frailty is at increased risk of long term institutional care, hospitalisation, prolonged length of hospital stay and mortality, and will require specific interventions that span several health and social care services to enable them to live well for their remaining years. Continue reading

Sarcopenia; a key driver of physical frailty

Miles Witham is a Clinical Reader in Ageing and Health, University of Dundee, and is Deputy Editor for Age and Ageing.

The BGS Autumn Meeting 2016 saw the launch of the newest BGS Special Interest Group – the Frailty and Sarcopenia Research SIG. The inaugural session, held in the main auditorium in Glasgow’s SECC was attended by several hundred delegates, and so far, over 100 members have signed up on-line to be part of the new SIG. So why do we need this SIG, and what do we hope it will achieve? Continue reading

Older HIV-Infected Adults are Geriatricians’ Business

Fátima Brañas is a consultant geriatrician and the clinical lead for orthogeriatrics at the Infanta Leonor University Hospital in Madrid (Spain). She holds a PhD, specializing in HIV infection in older adults, and is working hard in this field—from both a clinical and a research point of view—to provide all the benefits of a geriatric assessment for older HIV-infected adults. She recently co-authored ‘Frailty and physical function in older HIV-infected adults @FatimaBranas

hivThe HIV-infected population is aging due to the success of combination antiretroviral therapy, which prolongs survival, and also because of the growing number of newly diagnosed cases in older adults. Nowadays, over half of people infected with HIV are older than fifty years, which is the age cutoff accepted by the scientific community to consider someone an HIV-infected older adult. Fifty is only their chronological age, but biologically they are older, as accelerated aging in this population has been demonstrated. So, it seems that in the coming years, HIV care is going to be focused on a growing group of older adults and their specific problems. This means more than only survival, infection control, or avoiding the adverse events caused by antiretroviral drugs; it also includes consideration of comorbidities, polypharmacy, functional decline, and geriatric syndromes. Continue reading

Joining up care for older people with frailty

Across the UK, innovative collaborations between GPs and specialist geriatricians are paving the way to better care for older people with frailty

rcgp-bgd-coverA new joint report from the Royal College of GPs and the British Geriatrics Society has been published today, showcasing how GPs and geriatricians are collaborating to design and lead innovative schemes to improve the provision of integrated care for older people with frailty.

Advancements in medicine are a great success story, and as a result our patients are living longer, but they are also increasingly living with multiple, long term conditions and that brings a number of challenges for general practice and the wider NHS.

Older patients make up the majority of those attending GP surgeries and acute hospitals so getting the right combinations of care in the right place and at the right time is crucial to avert avoidable admissions and delayed discharge from hospital. Continue reading

Palliative care for frail older people: what, when and how?

Anna Bone is a Cicely Saunders International PhD Training Fellow in the Department of Palliative Care, Policy, and Rehabilitation at King’s College London. In this blog Anna discusses her recent Age and Ageing paper on developing a model of palliative care for frail older people. This is part of the OPTCare Elderly Study, a joint project between King’s College London and Sussex Community NHS Foundation Trust, led by Dr Catherine Evans. @AnnaEBone

aaIn the minds of many, palliative care is synonymous with cancer and end of life. This is unsurprising, as it is within this context that palliative care has developed. The goal of palliative care is to relieve suffering and improve the quality of life of people with life threatening illness. It is increasingly believed that palliative care has much to offer to other patient groups whose health is deteriorating, and not just at the end of their life.
People are now living longer, with multiple chronic illnesses and frailty, and dying at older ages. We need to consider the needs of this growing group. Specialist palliative care services for frail older people with deteriorating health may provide an extra layer of support to help them and their families live as well as possible. Continue reading

A Bespoke Blue Light Response to Frail Older Fallers: Makes Complete Sense – But Does It Work?

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

South Western Ambulance VX09FYPWith 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

Translating Isaacs

Professor Kenneth Rockwood has published more than 300 peer-reviewed scientific publications and seven books, including the seventh edition of the Brocklehurst’s Textbook of Geriatric Medicine & Gerontology. He is the Kathryn Allen Weldon Professor of Alzheimer research at Dalhousie University, and a staff internist and geriatrician at the Capital District Health Authority in Halifax in Canada. 

chinaIn May 2016 I was honoured to speak about frailty at the Chinese National Geriatrics Conference in Beijing. The audience, not just geriatricians, was people who care for frail older adults. They recognized in geriatric medicine the tools and concepts needed to improve the care of those patients.

For that reason I found myself discussing how best to translate the great Bernard Isaacs’ nicely alliterative phrase “Geriatric Giants. In The Challenge of Geriatric Medicine (Oxford: OUP, 1980) Isaacs elaborates them, also alliteratively, as “instability, immobility, incontinence, intellectual impairment/memory and impaired independence”. These were key ways in which patients and their families understood that “something was wrong”. Continue reading