Palliative care provisions are not meeting the needs of an ageing population

A commentary published today in Age and Ageing, the scientific journal of the British Geriatrics Society, warns despite the fact that frail older people with multiple illnesses and end stage dementia are the most rapidly growing group in need of palliative care current provisions are not aligned to meet their needs.

The authors of the commentary noted that current projections indicate that between 25% and 47% more people may need palliative care by 2040 in England and Wales. A high proportion of these people will die following a prolonged period of increasing frailty and co-morbidity including cancer, but also other long-term conditions such as heart failure, chronic obstructive pulmonary disease, diabetes or renal failure. Continue reading

Using population sub-segmentation to promote tailored end of life care in later life

Professor Martin Vernon is National Clinical Director for Older People and Person Centred Integrated Care at NHS England. He tweets @runnermandoc. Dr Dawn Moody is Associate National Clinical Director for Older People and Integrated Person-Centred Care for NHS England. She tweets @Moody_D_K. They will be speaking at the BGS Living and Dying Well with Frailty event today. Follow the conference via #bgsconf

Frailty is an especially problematic long term condition characterised by declining intrinsic capacity to deal with stressor events such as acute illness or physical accidents. When severe it significantly increases personal annual risk of reaching end of life. While occurring alongside human ageing, not everyone develops frailty and it is not solely confined to older people. NHS England estimates 20% of the population aged 90 and over remains fit and are therefore likely to be fortunate in ageing well. Conversely we estimate that up to 25% of people aged 65 to 69 are living with mild frailty in England which compared to their fit peer group places them at twice the annual risk of reaching end of life.  A further 5% of this age group is estimated to be living with moderate or severe frailty. Continue reading

Can a National Frailty Education Programme be a driver of culture change in healthcare?

Dr Diarmuid O’Shea is a Consultant Geriatrician at St Vincent’s University Hospital in Dublin, Ireland, and Deirdre Lang is the Director of Nursing, National Clinical Programme for Older People, Royal College of Physicians of Ireland and Health Services Executive

We all know that population ageing is occurring rapidly. Between 2015 and 2030 the number of people in the world aged 60 years or over is projected to grow by an extraordinary 56%. By 2050, the global population of older people is projected to more than double its size (United Nations, 2015). In Ireland, the population 65 years and over is projected to increase by between 58 and 63 per cent from 2015 to 2030. The older old population (i.e. those aged 80 years of age and over) is set to rise even more dramatically, by between 85 per cent and 94 per cent in this time period (ESRI 2017). Continue reading

Specialist Care Frailty Network – we need your help!

Dr Simon Conroy is a geriatrician at University Hospitals of Leicester, Honorary Senior Lecturer, University of Leicester and an Associate Editor for Age and Ageing journal. 

Dear fellow BGS members,

Some of you might have heard about the Acute Frailty Network, which has been in existence for a few years now. The focus of the Acute Frailty Network has been acute medical care and to some extent emergency care. The Specialist Care Frailty Network will focus upon the care of older people with frailty in six specialist services:

  • Renal Dialysis
  • Chemotherapy
  • Emergency Cranial Neurosurgery
  • Interventional Cardiology
  • Complex Spinal Surgery
  • Adult Critical Care

Continue reading

November 2017 issue of Age and Ageing journal is out now

The November 2017 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 in this issue include:
  • Multimorbidity
  • Frailty and recovery from acute illness
  • In-hospital geriatric consultation
  • Acupuncture for frail older people
  • Including older people in research

The Editor’s View article gives an overview of the issue with a summary of highlights. This article is free to read and can be viewed here. Continue reading

Fitter individuals are at the highest risk of death associated with delirium

Melanie Dani is a trainee in geriatric medicine in the North West Thames deanery. She is also completing a PhD at Imperial College London studying biomarkers in Alzheimer’s Disease, and has an interest in cognition and dementia.

It is well-recognised that delirium is associated with increased mortality. It’s less clear, though, whether this is the case across the spectrum of frailty. There is an idea that delirium might have bimodal outcomes – worse in frailer people, but may be protective in fitter individuals by highlighting an underlying problem early and (potentially) prompting earlier treatment.

While past studies have accounted for chronic diseases and acute illness severity, few have accounted for both. We wanted to see whether the associations of delirium with mortality remained so even after accounting for acute and chronic health factors, so we modelled both these together in a frailty index. This included 31 variables encompassing chronic disease, acute illness parameters, and functional status and was applied in a large cohort of acute medical older inpatients. Continue reading

Older people are living longer than before, but are they living healthier?

Ruby Yu is a research assistant professor at the Chinese University of Hong Kong (CUHK), specialising in gerontology and geriatrics. She is also a research fellow at the CUHK Jockey Club Institute of Ageing. Her recent paper Trajectories of frailty among Chinese older people in Hong Kong between 2001 and 2012: An Age-period-cohort Analysis was published today in Age and Ageing journal.

There is no doubt that people from countries all over of the world are living longer, but there is little evidence to suggest that older people today are living healthier than their predecessors did at the same age. This is a major cause of concern for many governments around the world because if the added years of people today are dominated by chronic diseases and functional disabilities, there will be negative implications (e.g., extended treatment for older people which increases the health and social care cost to society). Continue reading

Smoking linked to frailty in older adults

A recent paper published in Age & Ageing, the scientific journal of the British Geriatrics Society, finds that current smoking in older people increases the risk of developing frailty, though former smokers did not appear to be at higher risk.

Smoking increases the risk of developing a number of diseases, such as chronic obstructive pulmonary disease (COPD), coronary heart disease, stroke and peripheral vascular disease, all of which can potentially have negative effects on people’s physical, psychological and social health.

Frailty is considered a precursor to, but a distinct state from, disability. Frailty is a condition associated with decreased physiological reserve and increased vulnerability to adverse health outcomes. The outcomes include falls, fractures, disability, hospitalisation and institutionalisation. Continue reading

The frailty journey so far: where are we heading?

Professor Martin Vernon qualified in 1988 in Manchester. Following training in the North West he moved to East London to train in Geriatric Medicine where he also acquired an MA in Medical Ethics and Law from King’s College. In 2016 Martin was appointed National Clinical Director for Older People and Person Centred Integrated Care at NHS England. Here he discusses the 3rd National Frailty Conference which will be held on 28 September 2017 in Leeds. He tweets @runnermandoc 

The 19th Century term ‘watershed’ refers to a ridge of high ground separating bodies of water flowing in different directions. With this in mind I believe the 3rd National Frailty Conference in Leeds this year truly does mark a watershed moment. It will provide a valuable and timely opportunity both to reflect and add clarity to the new direction of travel we are taking with routine frailty identification and intervention for older people on a national scale. Make no mistake: bringing frailty into the mainstream is game changing.

Over the last year I have been continually impressed by the enthusiasm, ingenuity and commitment around the country focused on improving care and outcomes for our expanding and ageing population.  As a health and care system collectively we have much to celebrate from the hard work already done. Continue reading

Why I’m Fine with “Frailty”

Professor David Oliver is a Past President of the BGS, clinical vice-president of the Royal College of Physicians, and a consultant in geriatrics and acute general medicine at the Royal Berkshire NHS Foundation Trust. Here he responds to Steve Parry’s recent BGS blog, The Frailty Industry: Too Much Too Soon? He tweets @mancunianmedic

Dr Steve Parry’s recent blog here, “The Frailty Industry. Too much too soon” certainly generated a great deal of hits and online responses. He is a well-respected geriatrician, has done sterling work for our speciality and we are friends in a speciality where solidarity and mutual respect are wonderfully the norm.

The more I reflect, the more I realise that none involved in the debate are a million miles apart in any case. We have all devoted our professional lives to the skilled multidisciplinary care of older people, especially those with the most complex needs; to the speciality of geriatric medicine; to the leadership of local services; to the education of the next generation of geriatricians and to developing the evidence base for practice.  Continue reading