It’s not how old you are that matters, so much as how you are old…

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. He has been the British Geriatrics Society Champion for End of Life Care for 5 years and was a standing member of the NICE Indicators Committee. In 2016 Martin was appointed National Clinical Director for Older People and Person Centred Integrated Care at NHS England.

While celebrating successful ageing we must not be led into complacency. There is marked inequality between least and most socioeconomically deprived areas with men living on average up to 8 years less in the most deprived areas.

The NHS England Five Year Forward View notes that support for frail older patients is one of the three areas that the NHS faces particular challenges. It is therefore potentially game-changing that we are now making positive steps towards addressing this through routine frailty identification and promoting key interventions targeted at falls risk identification and medication review.

What happens to patients with abnormal cognition picked up by in-hospital dementia screening – Results from GP questionnaires

Sarah Pendlebury is Associate Professor in the NIHR Oxford Biomedical Research Centre and the Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford and Consultant Physician and Clinical Lead for Dementia and Delirium at the Oxford University Hospitals NHS Foundation Trust. Research and audit interests include cognitive impairment associated with cerebrovascular disease and the interactions between vascular disease, neurodegeneration, co-morbidity and delirium and in the use of short pragmatic cognitive tests in patients with stroke and acute illness. Here she reports on an audit of the actions undertaken by GPs in response to letters informing them of in-hospital identification of cognitive impairment in their patient, which will be presented at the upcoming BGS Spring Meeting in Liverpool.

Dementia and delirium are prevalent in older patients with unplanned admission to hospital and are associated with death and increased dependency, but many confused patients do not have a dementia diagnosis prior to admission. Routine dementia screening for older people (>75 years) hospitalised as an emergency is mandatory in England with onward referral for specialist assessment in those identified as at-risk (dementia CQUIN).

The eFI: a major advance in frailty care

Andy Clegg is a senior lecturer at Leeds University, and a consultant geriatrician at Bradford Royal Infirmary. Here, he discusses his recent Age & Ageing paper on a new breakthrough in frailty care.

Frailty is a condition that is common in older age. It develops because as we get older our bodies change, and can lose their inbuilt reserves. These changes mean that older people with frailty can experience sudden, dramatic changes in their health when they have an illness or injury.

International guidelines recommend that frailty should be identified routinely so that a more holistic approach to care can be taken, and effective treatments provided. However, the main difficulty with identifying frailty routinely is that the tools that are available, such as measuring walking speed, grip strength, or frailty questionnaires require additional resource, and might be inaccurate.

‘She’s been up at casualty with another fall’

Consultant geriatrician at the Queen Elizabeth Hospital in Birmingham and co-chair of the BGS Falls and Bone Health Section, Dr Jonathan Treml, advises on how to tackle this common tricky presentation in a ten minute consultation.  This article first appeared online in Pulse, a website aimed at GPs and other primary care professionals and which tweets @pulsetoday.

Falls are a common and potentially serious problem affecting around a third of older people each year. Often disregarded as an inevitable part of the ageing process by both patients and doctors, falls can be the first sign of frailty, disability and dependence.

Most falls in older people are the result of multiple risk factors, often including impaired gait, balance and mobility. Falls can be the presenting complaint of underlying pathology – including postural hypotension or syncope, vestibular or visual impairment, Parkinson’s or other neurological disease.

A doctor’s main roles in falls prevention are identifying and treating underlying problems, ensuring medication is reviewed for fall risk and bone health, and appropriate referral to falls prevention exercise programmes.