Category Archives: Cardiovascular

A specialist medical and mental health unit

Dr Rowan Harwood is‎ a consultant physician, professor of geriatric medicine at Nottingham University Hospital NHS Trust. Reblogged from the BGS Blog

Click here to go to video

Click here to go to video

There is a lot of criticism of how we manage cognitively impaired patients in acute hospitals. And advice on how to do it better. The hope has been that more expert and co-ordinated services would improve outcomes and save resources. But there has been little in the way of rigorous evaluation.

We developed a specialist medical and mental health unit with the ambitious objective of demonstrating best practice. We enhanced the ward environment, ward staffing and skill mix, including mental health specialist nurses, therapists and psychiatry, trained all staff to a high level in the person centred philosophy of care, and endeavoured to engage family carers more fully.

After 18 months of operation we ran a randomised controlled trial, published in the BMJ.This video abstract describes the intervention and trial results.To illustrate the challenges and capture the essence of compassionate person-centred care, we made a 23 minute documentary, called Today is Monday. Footage from this is used to illustrate the abstract.

The full 23-minute film is available for training purposes; interested readers are welcome to discuss this with me Rowan.Harwood@nuh.nhs.uk.

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November issue of Age and Ageing journal out now

Reblogged from the BGS Blog

The November 2013 issue of Age and Ageing, the journal of the British Geriatrics Society is out now.

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:

  • Screening for dementia
  • Cancer screening in later life
  • Diagnostic accuracy of temperature measurement
  • Dysphagia in patients with hip fracture
  • The Cochrane Collaboration and Geriatric Medicine

The Editor’s Pick can be read here.

This issue’s free access papers are:

Too old to drink? At risk drinking in over-75s

Prof Margda Waern, psychiatrist and professor at the Sahlgrenska Academy, University of Gothenburg. This has been re-blogged from the British Geriatrics Society blogdrinker

Health benefits related to mild to moderate alcohol consumption include better cardiac and cerebrovascular health, decreased risk of dementia and improved quality of life. This might help to explain why we are nowadays less likely to discontinue drinking as we age. There may, however, be a down side. Over-consumption of alcohol can increase risk of cognitive impairment, self-neglect and falls. Considering this, it is surprising that we know so little about the extent to which older people engage in potentially harmful drinking.

I was part of a group of researchers at the University of Gothenburg in Sweden who set out to study at-risk alcohol consumption in older people.  We did this using data from two long-running surveys on health and ageing: theH70 study and the Prospective Population Study of Women.  We compared at-risk drinking in two groups of 75-year-olds: 303 persons born in 1901, and 753 born three decades later in 1930. Participants were asked about their intake of beer, wine and spirits; at-risk drinking was defined as ≥ 100g/week (corresponding roughly to more than 2 drinks/day). We found at-risk drinking in 19% of men who took part in the mid-seventies study, compared with 27% of those who participated in 2005. There was a tenfold increase in at-risk drinking in women, from 0.6 % in 1976 to 10% in 2005.

We concluded that alcohol consumption has changed markedly in 75 year olds, especially in women. It is important to note that the study was set in Scandinavia, where gender differences may be less pronounced than in other parts of Europe. Studies are needed in varied settings in order to evaluate the health implications of changing trends in alcohol consumption in later life.

The full paper can be read in Age and Ageing today.

Sleep Disorders in older people

Kirstie Anderson is Project Leader at Newcastle University’s Clinical Ageing Research Unit, for the ICICLE Sleep Study. (Reblogged from the British Geriatrics Society blog).sleepy

Sleep is a biological imperative, famously described as “of the brain, by the brain and for the brain.” In young and middle aged volunteers, sleep restriction can be shown to adversely affect memory formation, consolidation and mood. Sleep disorders including insomnia, obstructive sleep apnoea and restless legs all increase in prevalence with age but the effects of disturbed sleep in the oldest age groups are still poorly understood. Sleep becomes increasingly fragmented, although total sleep time does not change significantly and there is weakening of the circadian rhythm which is likely to be both biological and environmental. Continue reading

Adults in later life risk damaging mental health by excessive use of alcohol

Dr Joss Bray MRCPsych MRCGP, is the Medical Director for Addictions Services,The Huntercombe Group in the United Kingdom

alcoholismThis year World Mental Health Day focuses on the potential for older people to enjoy a full and active life in their later years[1]. However, an area of rising concern, particularly within the UK, is the increasing tendency for over 65s  to drink levels of alcohol that are potentially harmful to their health.

According to a recent study by the University of Sunderland, 28% of men over 65 years and 14% of women over 65 now drink alcohol more than five times per week in England[2]. Heavy drinking within this age group is strongly linked with depression and anxiety and loss of mental alertness as well as longer term physical health problems.  Continue reading

Hypertension in people with dementia – what should we do?

Tomas Welsh is a Clinical Lecturer in the Medicine of Older People at the University of Nottingham, England. (First blogged on the BGS blog)

Antihypertensive therapy is effective even in the oldest old. However, the large trials of antihypertensive medications, even in older people, frequently excluded people with dementia. This causes difficulties in applying these findings to many of our typical patient group.

People with dementia are more likely to be physically frail, are at higher risk of adverse events due to polypharmacy and are more likely to experience orthostatic hypotension than their cognitively intact peers.  There is reason to suspect, therefore, that the risk-benefit ratio of treating hypertension may be different in this group and many clinicians intuitively feel this to be the case.   Continue reading