Can doing nothing sometimes be the best approach?

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.

You may have seen recent stories in the national media about a new campaign launched by the Academy of Medical Royal Colleges called Choosing Wisely. It says that patients should be encouraged to ask if tests are really needed, that doctors should discuss potential harms of treatment with patients, and calls for experts to develop lists of common practices that should be stopped.

The IDEAL Project – living well with dementia

John Hindle is a consultant geriatrician in Wales. He is one of the co-investigators on the IDEAL project.

IDEAL is a major, five-year longitudinal cohort study of 1,500 people with dementia and their family carers throughout the UK using mixed methods to examine how social and psychological capitals, assets and resources influence the possibility of living well with dementia and to identify changes that could result in improved well-being, life satisfaction and quality of life.

Nice one NICE: developing the policy narrative on preventing disability, frailty and dementia in later life

David Oliver (BGS President Elect and Consultant Geriatrician) and David Buck (King’s FundSenior Fellow, Public Health and Inequalities) discuss the National Institute for Health and Care Excellence (NICE)’s new guidelines on preventing disability, frailty and dementia in later life. The article can be read in full on The King’s Fund Blog:

Life-expectancy is now 79 for men and 83 for women, and when we reach the age of 65 we can expect to live another two decades on average.

Living longer lives is a cause for celebration but there are still major inequalities in life expectancy and healthy life expectancy at birth, in rates of premature deaths, and in life expectancy at 65 between different socioeconomic groups. We also face a rising prevalence of long-term conditions, dementia, disability and frailty related to rapid population ageing, which has big implications both for individuals and for health and social care systems.

The holy grail of prevention would be to reduce inequalities in the health of older people, to improve their overall health and to ‘compress morbidity’, delaying the onset of poor health until the last few years of life. The King’s Fund has contributed to this debate with its work on adult behaviour change and improving care for older people, and its Time To Think Differently programme of work. But now, somewhat surprisingly, the National Institute for Health and Care Excellence (NICE) has added its voice, in the guise of guidelines released for consultation on preventing disability, frailty and dementia in later life.

‘So what?’ you cry, yet another bunch of stuff to wade through. But this time it’s different – what is so interesting about these guidelines is not so much the detail but the principles and linking themes behind them, and the fact that, instead of just advising clinicians, the guidelines include direct advice to the government on health and wider social policy.

So what’s in it? For starters, NICE calls for government interventions to make smoking and drinking less affordable and accessible; and to make the maintenance of healthy weight and regular exercise more affordable and accessible. Hardwiring these recommendations on affordability into local and national public health strategies is a challenge to those, of any party, who do not see price as a policy lever on behaviours other than tobacco use. Given that Public Health England also supports minimum unit pricing of alcohol, two important government health bodies have now put their cards on the table….[continues]

Read the article in full on the King’s Fund Blog

The British Geriatrics Society welcomes the NICE Delirium Quality Standards

Duncan Forsyth is Consultant Geriatrician in Cambridge and was a specialist adviser to the Quality Standards Development Group.

On July 24^th 2014, NICE published its Delirium Quality Standards to assist health and social care drive-up the quality of delirium management in hospital and care home settings. The standards cover: assessment; prevention; use of antipsychotic medication; communicating the diagnosis; information and support to those who have delirium and their carers. Delirium is probably the commonest complication of hospitalisation in older people and has a high prevalence in those in long-term care.

Atrial Fibrillation: The real story behind the new NICE guidelines

Richard Bogle is a Consultant Cardiologist based in London and Surrey. He specialises in the assessment and treatment of patients with all types of heart and vascular disease. He tweets at @richardbogle

If you watched the news this week you might have thought that the only recommendation in the NICE Atrial Fibrillation Guideline was that doctors should not prescribe aspirin to prevent strokes. In fact most cardiologists and geriatricians stopped using aspirin for this condition several years ago and the NICE recommendation simply reaffirms those issued previously by other professional societies such as the European Society of Cardiology.

The real story behind the guidelines was, in my opinion, nothing to do with medication or rate versus rhythm but rather the importance of delivering a personalised package of care for patients with atrial fibrillation (AF). Recognising that AF is a long term health condition there is emphasis on the importance of shared decision making processes particularly around anticoagulation. Alongside the guideline NICE published a Patient Decision Aid to assist with this process. 

The government and the “societal benefits” of care

Zoe Wyrko is a Consultant Geriatrician at Queen Elizabeth Hospital Birmingham and is the workforce planning lead for the BGS. She tweets at @geri_baby

I like to think that as a jobbing geriatrician I have a fairly pragmatic attitude towards guidelines. I know that they exist, but I also know that they are not always directly applicable to a frail older person with multiple morbidities, so I’ll look at what they say with a hint of scepticism, and use them when they help me to provide the best care. Extrapolating from this, I tend to see NICE as an organisation that is more for other people than me. I know that the work they do is vital in standardizing care, bringing together groups of experts to decide on treatment pathways and helping to make decisions on which drugs to give when. I have even attended a stakeholder group for the preliminary stages of the guidance they are planning to issue for social care.

This week however, a statement made by Sir Andrew Dillon, head of NICE, has made me sit up and pay attention. It seems we should be afraid… very afraid.

June issue of the BGS Newsletter out now

The June issue of the BGS newsletter is available here.

Highlights include:

• Osteoporotic vertebral compression fractures – new NICE guidance by Opinder Sahota and Nasir A Quraishi
• Patients First and Foremost. The goverment’s response to Francis and what it could mean for us and our older patients by Professor David Oliver
• Letter to the Editor: Francis cannot define compassionate care but we can still practise it by Iain Wilkinson
• BGS Belfast Spring Meeting Conference Report by Liz Gill
• The Pearl programme – a specialised dementia service
• Unlocking gridlock in hospitals – a digest of two reports published by The Health Foundation, as part of the Foundation’s “Flow Cost Quality Programme”

Commissioning hip fracture care – the NICE way

Dr Karthik Kayan is onsultant orthogeriatrician at Stockport NHS Foundation NHS Trust.

Prof Opinder Sahota is consultant in elderly medicine at Nottingham University Hospitals NHS Trust and Joint Chairman of the Falls and Bones SIG at the BGS.

It is well known in geriatric medicine circles that hip fractures are the most common osteoporotic fracture affecting predominantly older people.

Currently, the incidence of hip fracture emergency admission is around 70,000 in the UK and will continue to increase as the population ages. The projected incidence for hip fracture in the UK is 101,000 by 2020. The crippling effects of hip fracture are significant for the patient as independence is affected and a number of them die within a year of sustaining a fracture. The cost of managing osteoporotic fractures is £1.7 billion and over 90 per cent of this is due to health and social care costs associated with the fracture.