July issue of Age and Ageing journal out now

The July 2016 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:

• Frailty index based on basic laboratory and clinical measures
• Dietary protein and ageing
• Do you want to live to be 100
• Social engagement and cognitive ageing
• Selective serotonin reuptake inhibitors and progression of dementia

The Editor’s View can be read here.

This issue’s free access papers are:

• Sex differences in the risk of receiving potentially inappropriate prescriptions among older adults

• Diagnostic test accuracy of informant-based tools to diagnose dementia in older hospital patients with delirium: a prospective cohort study

• Do you want to live to be 100? Answers from older people

Education as protector against dementia, but what exactly do we mean by education?

Francisca S. Then is researcher at the Institute of Social Medicine, Occupational Health and Public Health (ISAP) and the LIFE – Leipzig Research Center for Civilization Diseases at the University of Leipzig, Germany, with a major research focus on the epidemiology of cognitive decline and dementia. She discussed her recent Age & Ageing paper ‘Education as protector against dementia, but what exactly do we mean by education?‘

Attaining a higher level of education is considered to be important in order to keep up good cognitive functioning in old age. Higher education also seems to decrease the risk of developing dementia. This is of high relevance in so far that dementia is a terminal disease characterized by a long degenerative progression with severe impairments in daily functioning.

May issue of Age and Ageing out now

The May 2016 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:

• Electronic frailty index
• Exercise to reduce fear of falling
• Involving care home residents in research
• Patient knowledge of prescribed medicines
• C-reactive protein, frailty and multimorbidity

The Editor’s View can be read here.

The push to improve stroke services

Adhi Vedamurthy is a consultant geriatrician with a special interest in stroke, and Chair of the BGS Wales Council.

It was a typical Monday morning in a district general hospital. Loads of elderly medical patients had spent the night in the emergency department waiting for a bed. About a dozen ambulances were outside the hospital unable to offload patients.

I had just done a third of my ward round with the foundation year one doctor when the bleep went off. A patient with potential need for thrombolysis had just arrived. Apart from the stroke nurse, there was no other suitable senior doctor available to assess the patient.

I abandon the ward round to assess the patient, organise the scan, push the trolley with the stroke nurse to take the patient to the stroke unit and initiate thrombolysis. This takes nearly an hour. During this time, the patients on the ward are still waiting for my assessment and management plan. Two discharges get delayed and a few scans were not booked on time and they had to wait for another day.

This scenario is very common in many hospitals where geriatricians have more than one role. Time is of the essence when treating stroke patients, but this comes at a cost if commissioners do not invest to improve services and expect existing services to stretch. This also applies to therapy services who are asked to prioritise stroke patients.

To meet targets, a patient with a suspected stroke (many do not have a stroke) must get a bed in a stroke unit within four hours. But it seems entirely acceptable for patients with heart failure, pneumonia, a fall, delirium, etc., who have far higher mortality, to spend hours on a trolley in the emergency department.

There is no argument that acute stroke is an emergency and should be treated accordingly. However this should not come at the expense of other services in geriatric medicine.

A majority of geriatricians in Wales felt that an improvement seen in stroke services has come at the cost of compromising services in geriatric medicine.

Is this the case in the other devolved nations? I would love to hear your views.

Which one is a better deal – home visits or phone calls?

Frances Wong is a professor at the Hong Kong Polytechnic University. 

Our recent research has revealed very interesting findings about the power of a telephone call as compared to home visits for post-discharged patients. Patients are discharged from the hospital as soon as the immediate problems are resolved. Some care issues only emerge when the patients return home. The issues usually involve patients’ confidence and ability for self-care, symptom management, adherence to medication regimen and so on. If these concerns are not addressed properly, the patients will present themselves to the hospitals again. Like a revolving door syndrome, patients returning to the community come back to the hospital within a short time. The mean readmission rate within 28 days after discharge is 15% and the rate can escalate to 35% for the chronically ill patients. 

A new approach to providing continence care in an ageing population

Adrian Wagg is a Professor of Healthy Ageing at the University of Alberta, a regular author for the BGS Age and Ageing journal and General Secretary of the International Continence Society.

He will present a guest lecture on continence at the BGS Spring Meeting in March 2015. 

Incontinence is a hugely debilitating condition which affects millions of men and women worldwide.  Its incidence is rising as the proportion of people surviving into late life increases and with increasing rates of long-term conditions such as diabetes, heart disease and dementia for which it is a symptom or complication.  It has a huge impact on the lives of our patients and their caregivers, and comes at significant cost to health and social care services.  However, it remains one of the least discussed and most poorly understood conditions.

Earlier this year, along with colleagues Diane Newman, Kai Leichsenring and Paul van Houten, I undertook a review of the way continence service are organised, which was funded and supported by leading global hygiene company, SCA.

We concluded that there is a need for a greater focus on incontinence as a health and social care issue and to ensure that adequate resources are devoted to it.  In the UK, patients are still not being seen by the right professional at the right time.  The NHS needs to develop better models of multi-disciplinary working to ensure care is person-centred, and prioritises quality of life.

New clinical guidelines in Age and Ageing journal

David Stott is Professor of Geriatric Medicine at the Institute of Cardiovascular and Medical Sciences at the University of Glasgow and is Editor in Chief for Age and Ageing journal. 

Clinical guidelines are intended to help health care practitioners adopt best practice. Good guidelines have the potential to reduce variations to practice and improve patient outcomes while ensuring efficient use of health-care resources.

There are however a plethora of guidelines, often with contradictory advice and of variable quality.

Importantly, for care of older people, guidelines have often lacked relevance due to restricted focus on single-organ disease, ignoring the realities of frailty with multi-morbidity, cognitive impairment (acute and chronic) and disability. However this is gradually changing, and guidelines now are emerging that are directly relevant for care of frail older people.

Given the increasing importance of guidelines in clinical decision making, this year Age and Ageing has added clinical guidelines as a new category of article. The journal is now publishing both ‘stand-alone’ guidelines (3000 words) and commentaries (1500 words). Already two papers have been published; the best practice guidelines for the management of frailty by Turner and Clegg give advice on the management of frailty in community and outpatient settings. The summary of the National Osteoporosis Society Vitamin D guideline by Aspray et. al. charts a rational approach to the confusing topic of when to measure 25-hydroxy vitamin D, and when and how to treat. I am keen to encourage further submissions of high-quality guideline articles to Age and Ageing.

Must clinical guidelines be followed for all patients? Obviously not! Here we can follow the logic of Margaret Thatcher (Scott Enquiry) who said ‘…Guidelines are for the guidance of officials to be consistent. Of course they have to be followed, but they are not strict law. That is why they are Guidelines and not law and, of course, they have to be applied according to the relevant circumstances.’ Therefore guidelines should be seen as important in informing practice but not in dictating it.

Inappropriate drug use among older persons: is it time for action?

Andreas Schoenenberger works with the Division of Geriatrics, Department of General Internal Medicine at Bern University Hospital, and with the University of Bern, Switzerland. Here he describes his recent editorial in Age and Ageing journal, written with Andreas Stuck.

Despite recent efforts to improve drug management for older people, we have not yet arrived at an optimal strategy for reducing inappropriate drug use. Drugs are considered inappropriate, if the risk outweighs the potential benefit of the drug. Along with pathophysiological changes during the ageing process, and the increasing number of co-morbidities/-medications, the potential risks of drugs increase with age and adverse drug reactions (ADRs) are encountered more frequently in older persons.

January issue of Age and Ageing journal out now

The January 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:

• Deprivation of liberty safeguards
• Biomarkers for dementia
• Clinical features of delirium
• Physical therapy for knee osteoarthritis
• Integrated care for older people

The Editor’s View can be read here.

This issue’s free access papers are:

• The contribution of geriatric medicine to integrated care for older people

• Much more medicine for the oldest old: trends in UK electronic clinical records

• Alcohol consumption and physical functioning among middle-aged and older adults in Central and Eastern Europe: Results from the HAPIEE study

• Economic evaluation of the differential benefits of home visits with telephone calls and telephone calls only in transitional discharge support

Geriatric Medicine in the “little red dot”

Dr Liang Tee Lee is President of the Society for Geriatric Medicine, Singapore and a Consultant of Continuing & Community Care in Tan Tock Seng Hospital and Clinical Director at Ren Ci Hospital.

Singapore is a city state country in South-east Asia, often marked by a little red dot south of Malaysia on the world map. It spans 716 square kilometres and has around 5.4 million people. Singapore is one of the fastest ageing countries in the world, with the population of 65 years and older projected to increase from 10.5% now to 18% in year 2030.