March issue of Age and Ageing journal out now

The March 2014 issue of Age and Ageing, the journal of the British Geriatrics Society is out now.

A full table of contents is available here, with editorials, research papers, reviews, short reports, case reports book reviews and more. Hot topics this issue include:

• Sensor technology and falls
• Postgraduate training in dementia
• Gender, frailty and life expectancy
• Secular changes in alcohol consumption
• Music-based exercise and cognition

The Editor’s Overview can be read here.

This issue’s free access papers are:

• The demise of the Liverpool Care Pathway: should we ban the highway code because of bad drivers?

• Secular changes in at-risk drinking in Sweden: birth cohort comparisons in 75-year-old men and women 1976–2006

• REFINE (REducing Falls in In-patieNt Elderly) using bed and bedside chair pressure sensors linked to radio-pagers in acute hospital care: a randomised controlled trial

• C-reactive protein, APOE genotype and longitudinal cognitive change in an older population

• UK medical teaching about ageing is improving but there is still work to be done: the Second National Survey of Undergraduate Teaching in Ageing and Geriatric Medicine

 

The Future Hospital Commission: future-proof doctors need training in geriatric medicine

Dr Adam Gordon is a Consultant and Honorary Associate Professor in Medicine of Older People at Nottingham University Hospitals NHS Trust. He is Deputy Honorary Secretary of the British Geriatrics Society and also edits this blog. 

The report of the Future Hospital Commission, published last week, suggested we needed “a cadre of doctors with the knowledge and expertise necessary to diagnose, manage and coordinate continuing care for the increasing number of patients with multiple and complex conditions. This includes the expertise to manage older patients with frailty and dementia.”

The most evidence-based way to manage frail older people is Comprehensive Geriatric Assessment (CGA). CGA has consistently been shown in large meta-analyses and systematic reviews over the last 20 years to improve outcomes for older patients. These include – but are not limited to – decreased risk of cognitive decline and death, increased likelihood of functional independence and a lower probability of readmission to hospital.

Doctors don’t “do” CGA – it is delivered by a multidisciplinary team (MDT). It requires assessment across multiple domains (medical, psychological, environmental, social and functional), accompanied by case management and iteration of management plans.  The role of doctors is to provide diagnosis and prognosis, to initiate medical treatments where necessary and to do so with consideration to the broader management plan agreed with the MDT.

If doctors are to do this they need first to understand how CGA works.