Frailty and delirium – the Scottish approach

Christine McAlpine is a consultant geriatrician at Glasgow Royal Infirmary. She served on the Working Group which developed the BGS’ Fit for Frailty guidance and was Chairman for some years, of the BGS Clinical Effectiveness and Quality Committee.shutterstock_216372022

10% of patients admitted to hospital as an emergency stay more than two weeks, using 55% of all hospital bed days, and 80% of that group are aged over 65 years.

The average age of a hospital inpatient is over 80. Good care for older people in acute care is a key priority for health services.

In 2012 Healthcare Improvement Scotland (HIS) was asked by the Scottish Government to “improve acute care for older people by March 2014”. A review of the published evidence plus the themes coming from the inspections of acute care services for older people suggested there were opportunities for improvement in the care of frail older people coming in to hospital, and that in particular delirium was often undetected with resulting poor outcomes for patients (including higher risks of death or institutionalisation).

The Older People in Acute Care (OPAC) improvement programme was therefore set up. Continue reading

Dyson’s Law and the Medical Registrar: A frontline view

This is a follow-up to Dr Aroras’ earlier blog about the recent legislations surrounding Do Not Resuscitate [DNR] orders. Dr Suthahar, who is a final year geriatric registrar, reflects on the immediate impact of the legislation on the wards and the acute general take.shutterstock_139322513

They say change comes slowly to the NHS… Think of the time it takes for the latest NICE guidance, CQUINs, newest drug or quality measures to filter down to the frontlines of clinical work. However in one stroke Lord Dyson in his landmark ruling on DNR orders and the legal necessity to communicate the DNR order to the patient or family members, has effectively changed clinical practice overnight. Continue reading

Better care for older people

Niall Dickson is Chief Executive of the General Medical Council, sets out how the professional regulator is responding to the needs of doctors when treating older patients. Follow the GMC at @gmcuktaster week

Healthcare is very largely a business for the treatment and care of older people. This is a reality to which not many of us have really woken up.

While there is much talk of long-term conditions and co-morbidities, much of health service delivery and the public’s perception of what an effective healthcare system should be doing remains focused on heroic interventions, lives saved, and patients cured.

We bear some responsibility for this, as the regulator with responsibility for setting educational and professional standards. We have certainly overseen practice which has struggled to adapt to the different needs of a different generation of older people. All too often older people fall through the cracks of organisational and professional silos. We will always need specialist care but we also need to reinvent the generalist physician with the status and authority to co-ordinate care and treatment, and ensure that sufficient attention is given to patients’ mental health and well-being alongside their physical health. Continue reading

Do Mention the F Word: Frailty and Policy

David Oliver is a Consultant Geriatrician in Berkshire and a visiting Professor in Medicine of Older People at City University, London. He is President Elect of the British Geriatrics Society.fffa_long

Frailty is something of an obsession for geriatricians. In a medical tradition based around “single organ” specialities and a branch of medicine which has sometimes struggled to make its identity distinct, its value clearer and its prestige higher, we know that older people with frailty and complex comorbidities are our bread and butter. And that applying skilled Comprehensive Geriatric Assessment, and whole systems, whole person care to a traditionally neglected group of service users defines what we do better than our non-geriatrician colleagues. Continue reading

Geriatric Medicine in the land of mountains and fjords

Marit Apeland Alfsvåg is leader of the Geriatric Department at Stavanger University Hospital and Prof Annette Hylen Ranhoff is Professor of Geriatric Medicine at Diakonhjemmet hospital in Oslo and the University of Bergen.shutterstock_15274933

Norway has a long coast, fjords and huge mountain areas. The population is small with only 5 million people, and 4 million live in cities.

Norway has become part of the wave of ageing. The percentage of people who are 65 years or older is about 14% and is estimated to reach 23% in 2030. The care of the older people has been declared to be a national priority. Continue reading