Generation Geriatrician?

Felicity Jones is a final year medical student at King’s College London and current Junior Members Representative for the BGS: representing Junior Doctors and Medical Students on the Trainees Council. Reblogged from the British Geriatrics Society blogGG

Caring for an ageing population is a major challenge of our time. Across the world, societies are ageing, with wide-ranging impacts. Many overlook the huge contributions the over-65s make to our labour workforce, running the third sector, and as carers for friends and relatives. It’s easy for these contributions to be ignored in a narrative which at a societal level tends to focus the challenges of providing a comprehensive health and social care to an ever-increasing proportion of our society.

At only twenty-three, it’s unusual for me to be interested in these issues. Most of my fellow medical students struggle to comprehend what draws me to geriatrics. I tell them it’s because I’m interested in health systems, quality improvement and leadership, because I’m intrigued by the complexities of how to flourish in our society once you hit retirement age, because I care about each and every older person I meet and want to see them supported holistically… but most of all because I’m young.

Our generation will be caring for an unprecedented number of older people, and managing an ageing challenge on a scale that today’s consultant geriatricians, healthcare managers and government have never experienced. As we become consultants, we will inherit systems which are already failing to cope, and we will have to manage any chaos resulting from a continued failure to radically re-design policies. Therefore, as healthcare professionals of the future, do we not have a duty to not only learn about but also get involved in leading these developments?

‘But I don’t want to be a geriatrician, I want to be a neurologist, a dermatologist, or specialise in some medical specialty…’ I hear you cry. Do not kid yourself. Each and every one of us is going to be affected by this demographic shift, and we will all (ok, with the possible exception of paediatricians!) see increasing numbers of elderly patients, who are taking multiple drugs and have multiple comorbidities. Even you budding surgeons should sit up and take note – services such as POPS at St Thomas’ demonstrate we can expect increasing numbers of older patients to undergo surgery with successful outcomes if given the right support.  We all need to learn from the experience of existing geriatricians, and gain expertise in how to care for the complex elderly patient of today, who will become the commonplace patient tomorrow. As one of my friends at King’s said after our elderly care placement, ‘I just didn’t expect geriatrics to be so difficult – I thought it was just talking to people!’ He’s right that caring for this population is academically rigorous, but he is also right that communication skills are critical: working with the elderly means thinking holistically about social, psychological and spiritual circumstances. Therefore, what better place to gain the skills and expertise you are going to need whatever you choose to specialise in?

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.

The frailty syndrome in the “frail” healthcare systems

Matteo Cesari, MD, PhD is Chargé de Mission at the Gérontopôle of the Centre Hospitalier Universitaire de Toulouse, researcher at the INSERM UMR1027, and Professor at the Université de Toulouse III Paul Sabatier (Toulouse, France). He is Editor-in-Chief of the Journal of Frailty & Aging. Reblogged from the British Geriatrics Society BlogFail lady

Our societies are ageing. The number of older people is steadily growing, threatening the sustainability of public services including healthcare. Age-related chronic and disabling conditions not only adversely influence older people’s quality of life, but also represent a burden for public health expenditures. It is a fact that something has to be done in order to prevent the (often irreversible) loss of physical function that occurs with advancing age. If we are to accomplish such an ambitious task, a major revision is needed in our approach to older people and, consequently, in the concept of geriatric medicine. Continue reading

Working with GPs and Care Home staff to reduce emergency hospital admissions

R Lisk, K Yeong, A Nasim, B Mandal, R Nari, Z Dhakam presented their research at the Autumn conference of the British Geriatrics Society. Reblogged from the British Geriatrics Society blogshutterstock_45287182

Residents of Care Homes with Nursing tend to be frail, have multiple diagnoses and high levels of dependency.  This results in complex care needs. Many experience multiple admissions to hospital, often with long lengths of stay.

This initiative was aimed at reducing the number of emergency admissions to our Trust from local Care Homes with Nursing, by working in partnership with staff in the homes and local GPs.  The aim was to help provide more bespoke care for this vulnerable patient group, keeping them out of hospital whenever it was possible and appropriate to do so.  The project was also part of a Trust-wide response to the new emergency admission cap introduced through the National Operating Framework 2010/11. Continue reading

Frailsafe: A new checklist for the acute care of frail older people

Professor Tom Downes is  consultant geriatrician and has expertise in the design of acute interface geriatric care. He is the Clinical Lead for Quality Improvement at Sheffield Teaching Hospitals. Saira Ghafur is a Quality Improvement and Leadership Fellow and Respiratory Registrar at Sheffield Teaching Hospitals NHS Foundation Trust. Reblogged from the British Geriatrics Society blog.

‘Something as mundane as a checklist can be a powerful tool for simplifying the complexity of the world and, in the context of medical procedures, save lives’ Atul Gawande 2010

FrailSafe

International studies have indicated that approximately 10% of all patients who are admitted to hospital suffer some form of adverse event (AE)- defined as an unintended harm to a patient resulting in injury, death or a prolonged admission.  Older people are more likely to suffer AEs and the consequences of these are often more severe in frail, older patients. Continue reading

The more you study, the later you drop – Education and terminal cognitive decline

Graciela Muniz-Terrera is a Senior Investigator Scientist at the MRC Lifelong Health and Ageing Unit at UCL. Reblogged from the British Geriatrics Society Blogshutterstock_21757213

The terminal decline hypothesis suggests an acceleration of rate of cognitive decline before death, although information about the onset of faster decline is inconsistent and varies by ability examined. The identification of factors that may delay such onset is crucial for policy implementation, as such delay would imply that individuals spend a shorter period of time in the fast declining stages of life. Education is a modifiable risk factor usually considered as a proxy for cognitive reserve that has been shown to be associated with cognitive function and, in a few American studies, has also been shown to be associated with a later onset of pre-clinical dementia. Continue reading