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.

Old problems, new solutions

Alistair Burns is Professor of Old Age Psychiatry and Vice Dean for the Faculty of Medical and Human Sciences at The University of Manchester. He is the National Clinical Director for Dementia and Older Peoples’ Mental Health, NHS England. This blog was originally published on the NHS England website. He will be speaking at the upcoming BGS Autumn Meeting in London.

As now seems to be tradition, let’s start with some statistics.

Up to four out of ten people over the age of 65 experience mental health problems. Depression is both the most common and most treatable mental illness in old age, affecting one in five older people in the community. This figure doubles in the presence of physical illness and trebles in hospitals and care homes. Nor should we forget that older people also experience severe mental illnesses.

About one fifth of all suicides happen in older people. Risk factors include: being male, being widowed, increasing age, social isolation, physical illness – present in up to 80 per cent of cases – pain, alcohol misuse and depressive illness past or present.

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 3^rd National Frailty Conference which will be held on 28 September 2017 in Leeds. He tweets @runnermandoc 

The 19^th 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 3^rd 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.

Person-centred care: fantasy, fad, or far-reaching in its potential?

Jacquie White is Deputy Director for Long Term Conditions, Older People and End of Life at NHS England, and tweets at @jaqwhite1. In this blog, she discusses person-centred care and NHS England’s new “Our Declaration” campaign.

Person-centred care seems to be the latest thing the NHS has suddenly started to get excited about, but is it of value, will it last, or is it just another fad?

Measuring up with ICHOM

Asan Akpan is a community geriatrician in Merseyside and research fellow for the Older Persons Working Group at the International Consortium for Health Outcomes Measurement. In this blog, he introduces ICHOM’s work and calls for your involvement. 

There’s a growing consensus around how to provide optimal care for people with multiple conditions: this involves comprehensive, continuous care and oversight. Structures and processes should focus on the person receiving care, allowing them to determine their own preferred outcomes.

Anywhere you look, a common theme is variation in care outcomes within and between healthcare organisations. Traditionally, outcome measures tend to be designed for episodic care, are focused on processes rather than people, and usually aren’t standardised. When different parts of the same healthcare organisation (or different organisations) want to compare their performance, interpretation of the outcomes is unreliable. This often impedes the important work of improving care across departments and organisations.

Coalition, co-production and collaboration

Ed Gillett is the Communications & PR Manager for the British Geriatrics Society. In this blog he introduces the work of the Coalition for Collaborative Care

As the current coalition Government goes into pre-election purdah (you should read our BGS policy paper on the general election, if you haven’t already), another very different coalition is just beginning to spread its wings. This is the Coalition for Collaborative Care, which now boasts the BGS as a partner organisation alongside ADASS, National Voices, NHS England, the Royal Colleges and many others.

The NHS England Five Year Forward View: part 2

This is the second of two blogs by BGS President David Oliver, focusing on the recent launch of the NHS England Five Year Forward View. Read part one here.

In my blog on 24th October, I described the crucial marker that this document has laid down for the mid-term future of English Health and Care services and the “big picture” implications. Here I want, in the words of the “Dragon’s Den” voice-over, to “drill down” into some of the key features and their implications for fellow BGS members.

Whilst we deal with the consequences of preventable ill health in older age, the report’s focus on prevention across the lifecourse is commendable. We know that there are major inequalities in life expectancy and healthy life expectancy at 65 and that around half of all poor health in older age is attributable to life style factors. So its good to see a clear challenge to government around diet, obesity, alcohol, cigarettes and exercise and the need to move away from “nudge” and “responsibility deals” to more proven preventative interventions.  We also welcome the greater focus on local government’s role in reducing social isolation or improving housing for older people. And on the untapped contribution that volunteers can make to helping older people remain connected and active – as well as the benefits  for older people who are volunteers.

Curiouser and curiouser: the changing numbers in dementia diagnosis

Tom Dening is Professor of Dementia Research at the Institute of Mental Health at the University of Nottingham. He tweets at @TomDening

Dementia is getting more common as the population of the UK and, for that matter, the world gets older. But just how common? How many people are out there? It’s a really important question for us all.

There have been some interesting developments over the last year. Until then, the official figure was 800,000 in the UK. This was based on projections from the MRC Cognitive Functioning and Ageing Study (CFAS), data that were collected during the 1990s, and updated based on the demographic profile of the elderly population since then. So this figure was based on numbers around 20 years old.

Therefore it was important to replicate the study and eventually CFAS II was funded and carried out. The team reported their findings in the Lancet last year.