Accurate delirium screening when there is no carer available – impossible, right?

Suzanne Timmons is a geriatrician working in Mercy University hospital, Cork and a senior lecturer in University College Cork. She has a big clinical and research interest in delirium and dementia care in hospitals.

delirium-flatDelirium  is common in older people admitted to hospital, and is a serious condition that needs to be identified quickly on admission. But many busy hospital staff still don’t routinely screen older people for delirium, even when they have known dementia (dementia puts people at very high risk of delirium: see the Cork Dementia Study).

In this study, we tested out five simple cognitive tests to see if they could be used to screen for delirium. The tests were: the Six-item Cognitive Impairment Test (6-CIT; measuring attention, orientation to time, and short-term memory); the Clock-Drawing test; Spatial Span Forwards (pointing to a sequence of squares in a certain order); reciting the months of the year backwards (MOTYB); and copying a shape containing two intersecting pentagons. Continue reading

John’s Campaign Conference; Stay with me

Liz Charalambous is a qualified nurse on a female, acute medical HCOP (Health Care for Older People) ward at Queen’s Medical Centre, Nottingham University Hospital Trust. She was one of the speakers at the John’s Campaign Conference. She tweets at @lizcharalambou and is a regular guest blogger for the BGS.

johns-campaignI was proud to be invited to speak this week at the John’s Campaign Conference on 12th October. The conference proved to be an oasis of light, love, and hope in the often gruelling and lonely journey of dementia. Nicci Gerrard and Julia Jones, co-founders of John’s Campaign, who both have personal experience of caring for loved ones with dementia, pulled together a groundbreaking and heartwarming conference, which was nothing short of miraculous. Nicci and Julia began what they described as a ‘kitchen table revolution’ to campaign to change the draconian restricted visiting arrangements of adult hospital care, advocating that people with dementia should have the support of their loved ones while in hospital. Continue reading

Time to move: Get up, Get Dressed, Keep moving

Dr Amit Arora is a Consultant Physician and Geriatrician at University Hospital of North Staffordshire, Stoke on Trent and an Honorary Clinical Lecturer at Keele University.

deconditioning-1Many years ago I was subject to restricted mobility following an emergency appendicectomy. It took me a surprisingly long time to regain my strengths and abilities- I noted that despite the youth and the will, my muscles would not move and it took a while to recover back to normal!

When I co-relate this to the frail older people that I see in hospitals, I can understand why someone who was able to function well before they came to hospital takes longer to regain their pre-admission functionality.  Prolonged hospital stay, bed rest and attendant risks may lead to loss of muscle power, strength and abilities. This is something we surely need to avoid. It should help achieve a shorter length of stay, better outcomes for patients and better ability at discharge. Continue reading

Sleep outs – nemesis of every clinician

Adhi (V Adhiyaman), geriatrician and Chair of Welsh council of the BGS. Tweets at @adhiyamanv

bedEvery clinician hates having sleep outs. Sleep outs or outliers used to be a rare occurrence in the past and happened only in extremely busy winter months. Now it is a norm due to reduction in bed capacity across England and Wales. In every hospital there are around 15-30 sleep outs at any time (even more if one includes the patients in emergency department waiting for a medical bed).

Most of the sleep outs are direct admission of medical patients to non-medical wards. It is not the clinicians who decide the sleep outs anymore. Bed managers make this decision and frequently hassle the medical registrars to identify sleep outs so that they don’t have to take the ownership of their decisions. Registrars are fed up of doing this as they are always busy with the take or dealing with other medical issues.    Continue reading

Which screening tool(s) should clinicians use for the detection of delirium in older, hospitalised patients?

Kirsty Hendry is a research assistant based at Glasgow Royal Infirmary having recently completed her PhD at the University of Glasgow. In this blog she discusses her recent Age and Ageing paper looking at screening of delirium in older, acute care in-patients. Kirsty can be contacted at Kirsty.Hendry0@gmail.com

A&ADelirium, suggested to be the most common psychiatric disorder suffered by older hospitalised individuals, has a low clinical awareness. This is despite existing guidelines such as those produced by the National Institute for Health and Care Excellence (NICE) and Healthcare Improvement Scotland (HIS) being in general agreement that delirium screening is important in older hospitalised patients.  Continue reading

If it’s everyone’s business, lets make a plan

Pamela Levack is Medical Director of the charity PATCH – Palliation And The Caring Hospital contactus@patchscotland.com

patchDavid Oliver’s recent blog in the BMJ End of Life Care in hospital is everyone’s business, reports on the findings of the recent Royal College of Physicians Audit into End of Life Care. The two main findings, a need to increase the number of specialist palliative care doctors and specialist palliative care nurses in hospital and to ensure that newly qualified doctors have more knowledge and confidence dealing with end of life situations, match the aims of our recently established charity PATCH Palliation And The Caring Hospital Continue reading

Hip fracture patients treated at orthogeriatric units received better quality of care and have a lower mortality.

aaPia Kjær Kristensen is a PhD student at Aarhus University Denmark. Her study on orthogeriatric care among hip fracture patients is published in Age and Ageing. She tweets at @pia_kjar 

Each year, 70-75,000 older people suffer a hip fracture that requires surgery in the UK. These hip fracture patients have a high risk of in-hospital mortality – a risk that clearly exceeds that of elective total hip replacement even accounting for differences in age, sex and comorbidity.

Continue reading

The 12 Days of Christmas – a hospital doctor’s lament

4980cbdcDavid Oliver is the current President of the BGS, a visiting Fellow at the Kings Fund, and a consultant in geriatrics and acute general medicine at the Royal Berkshire NHS Foundation Trust.

This time last year, I wrote the “Geriatrics Profanisaurus” – all about words and phrases which should be banned when discussing older people. It triggered plenty of  responses “below the line”, adding to the list of ageist and ignorant language regarding healthcare for older people and went a bit “viral” online. Indeed, the BGS is now being followed by Roger Melly’s Profanisaurus on Twitter, as is occasionally “sweary geriatrician” Dr Wyrko.

As I started the precedent of a festive Presidential blog, I couldn’t resist my own re-write of the old favourite “The 12 Days of Christmas”. I say this as a frontline doctor who frequently disappears into an uber-busy acute medical unit, or emergency department and has inpatients who are increasingly frail and complex and often requiring step down health and social care services which are themselves over-stretched. It’s a very challenging environment both for staff, patients and families and one that I know colleagues right across the four nations face, especially in the winter months. Its important in letting off steam on this site – mainly read by clinicians, that we are all deadly serious about trying to provide the highest quality care for patients. So no fun is intended to be at anyone’s expense.

But here goes anyway: do join in, especially with a hearty “Five Interims”.

On the twelfth day of Christmas,
My true love sent to me:
Twelve “vacant” locums,
Eleven “bed meetings”,
Ten “points of access”,
Nine winter pilots,
Eight re-admissions,
Seven day working,
Six delayed transfers,
Five Interims,
Four hour breaches,
Three Iberian Nurses,
Two Norovirus,
and  an over-crowded ED…

I also sometimes find other songs going through my head that seem strangely appropriate to the jobs we all do. Here are one or two:

“Back in Black” …”I want my bed base back”  – with thanks to Los Bravos.

Or indeed “Back to Black” by Amy Winehouse. “Black Alert” that is – when we have as many beds as Bethlehem had room at the Inn. At such times, though I am a Man City Fan, “Simply Red” would be a welcome sight for once.

Talking of Amy, if I had a quid for every patient whom I have wanted to send to intermediate care for ongoing rehab, but has preferred either to stay in hospital or to go home with no rehabilitation and support, surely “They tried to make me go to rehab, I say No, No, No” fits the bill.

Allied to this is the Beatles “Hard Day’s Night” – not only applicable to overstretched on call teams and nurses but also when patients who don’t want to stay another hour in hospital say to me “Doctor, when I’m home…” and I do feel like replying “I know…everything seems to be right”.

Sadly it’s hard for many patients to understand that hospital consultants can’t click their fingers and magic up social care or community rehab places; I can see these patients singing Gwen Stefani’s “What you waitin’, what you waitin’ for?”

When it comes to falls resulting from postural instability, then we have to acknowledge the sage words of Miss Meghan Trainor: “It’s all about that Base”

Now over to the readers of this blog, for your suggestions! Nothing disrespectful or inappropriate, please or our Digital Media Editor will be in like Flynn and remove the post,  but if you can think of any more songs for the thread or any more lyrics for those twelve days, we’d like to hear from you!

Finally, let me wish you all a very Happy Christmas. And remember, winter pressures or not, the health service is an immensely rewarding place to work: our colleagues are troupers and caring for people at their neediest is a privileged occupation, however demanding it may be. But perhaps a bit of dark humour can help through the worst two clinical weeks of the year.

Dementia is not contagious

Daniel Sommer is a Core Medical Trainee in South East Thames. He is an aspiring Geriatrician. He tweets at @danielf90shutterstock_77424727

I am committed to a career in geriatrics partly because I want to help people with dementia live safe, happy and productive lives. Working on an acute geriatrics ward is an amazing privilege. I’m constantly overwhelmed by the humanity of the staff that I work with. They seem to have endless patience and a genuine enthusiasm for what they do. In the face of huge challenges, staff shortages and under funding, our staff members provide an astonishing level of care for all patients, especially those with dementia. We have dementia boards, dementia boxes, dementia specialist nurses, dementia pins, dementia stickers and dementia clocks.

It feels silly telling an interested and educated audience [yes, that’s you!] about cognitive impairment, but I feel it’s important to be mindful of the scale of dementia and delirium in society and in the acute hospital. According to the Alzheimer’s Society, 7% of over 65s have dementia. A recent BMJ paper indicated that 34.8% of acute hospital in-patients over the age of 80 suffer from delirium, and 50.9% of those had an underlying dementia. This is not something than any healthcare professional can ignore.

With the above in mind, you’ll have to excuse me if I get more than a little bit irritated and hurt that some patients and their relatives are offended by the word “dementia” or that they demand to be moved off the “ward full of lunatics” because it’s “bad for their health”. Continue reading

Making difficult decisions about the benefits and risks of thrombolysis treatment

Dr Aoife De Brun is a Research Associate at the Institute of Health & Society at Newcastle Universityshutterstock_114405178

An online survey investigating factors that influence clinical decision-making regarding intravenous thrombolysis for patients with acute ischaemic stroke has been launched. The project is funded by the NIHR Health Service and Delivery Research Programme and is led by researchers from Newcastle University.

We are recruiting clinicians who are involved in making the final decision regarding thrombolysis for patients with acute ischemic stroke.  By understanding how clinicians make difficult trade-offs between the potential benefits and risks of thrombolysis, we can design strategies to better support risk communication, consent and decision-making with patients in clinical practice. Continue reading