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Found 290 results
  1. Content Article
    Polypharmacy is a term used to describe when a patient is taking a number of medicines at the same time. This study in the British Journal of Clinical Pharmacology aimed to measure how common polypharmacy is and describe the prescribing of selected medications known for overuse in older people with polypharmacy in primary care. It was a multinational retrospective cohort study that used data from patients with a mean age of 75-76 years from six countries: Belgium, France, Germany, Italy, Spain and the UK. The results revealed a high prevalence of polypharmacy with more than half of the older population being prescribed at least five drugs in four of the six countries. Whilst polypharmacy may be appropriate in many patients, the authors found worryingly high usage of PPIs and benzodiazepines. The study's results support current efforts to improve polypharmacy management across Europe.
  2. Content Article
    Alzheimer’s Society estimates that there are currently around 900,000 people living with dementia in the UK. Unlike other major conditions, there is no national clinical pathway for dementia, and despite there being a national target, there is wide variation in dementia diagnosis rates across England.  Alzheimer’s Society commissioned The King’s Fund to explore the development of Integrated Care Systems (ICSs) through the lens of dementia diagnosis—to consider what opportunities ICSs present to approach dementia differently and to improve diagnosis rates by doing so. The research team explored enablers and barriers to improving dementia diagnosis through interviews with stakeholders and people affected by dementia in three case study ICSs.
  3. Content Article
    On the 22 January 2024 Assistant Coroner Sarah Bourke began an investigation into the death of Anoush Summers who died aged 77, on the 14 January 2024 at Homerton University Hospital.   The deceased was a frail lady who was prone to falls. She lived at home, alone, with carers who visited her twice a day. She had a wrist alarm. The wrist alarm was reported as broken and not working on the 6 January 2024, but it was not repaired or replaced. Sometime after 4.45pm on 11 January 2024 the deceased fell at home. She was found the next day by a carer, wearing her wrist alarm and taken to hospital where she died on 14 January 2024 of hypothermia. The absence of a working wrist alarm prevented her from being found sooner that she was and probably contributed to her death.
  4. News Article
    An assistant coroner has warned an east London council more people may die if it does not take action, after a "frail lady who was prone to falls" died of hypothermia at her home. Anoush Summers, 77, died in hospital in January after a fall days earlier. In a prevention of future deaths report, external, assistant coroner Edwin Buckett said Ms Summers' inquest concluded "the absence of a working wrist alarm prevented her from being found sooner than she was and probably contributed to her death". Ms Summers lived alone but received help from two carers from Supreme Care Services, and she was visited twice a day. After falling at home on 11 January, she was found the next day at 09:00 GMT wearing her wrist alarm and was taken to hospital. She died of hypothermia at Homerton University Hospital on 14 January. The assistant coroner said among issues he identified in her case "giving rise to concern" were: Her wrist alarm had been reported as broken and not working on 6 January, but "this was not replaced or repaired by the company engaged by the local authority", which meant Ms Summers could not call for help as "it did not work" None of the carers who attended her home after the wrist alarm broke on 6 January "ensured that steps were taken to replace the alarm" or reported the matter to the local authority The last carer to see her, who visited on 11 January, "was not aware that the wrist alarm did not work as she had not read the care notes", and "no clear instruction was given" about the extent to which carers should read these notes "None of the carers had been given any training, instruction or guidance on the testing of wrist alarms to ensure they worked properly when attending" There was not a "clear system identified between the company providing carers and the local authority as to the duties and responsibilities of each in the reporting of faults with wrist alarms" Read full story Source: BBC News, 26 June 2024
  5. Content Article
    In this opinion piece for The Guardian, Adrian Chiles describes how his father was unnecessarily transferred from a community hospital to an A&E department by a locum GP. This caused his father—who was largely alone, confused and without his hearing aids—great distress, and should have been avoided, as healthcare professionals said the transfer had been unnecessary. Adrian describes his father's rapid deterioration following the incident and his regret that some of his father's last days were spent—avoidably—in distress. He says, "The process, the system, the protocols, the whatever, take hold and the wrong thing happens even though everyone can see it’s wrong but is powerless to put a stop to it."
  6. Content Article
    In this article, Ashley Milne-Tyte looks at how older people are treated by healthcare professionals and the impact that negative views can have on their care and treatment. She highlights examples of older people being marginalised by healthcare professionals, who sometimes shout at their patients or speak to family members rather than addressing their older patient directly. Emphasising the harm that this can cause, she cites research that shows that medical bias towards older people can accelerate cognitive decline, increase anxiety and depression and shorten lifespans by up to seven-and-a-half years.
  7. Content Article
    Emergency general surgery performed among patients aged over 65 years represents a particularly high-risk population. Transferring emergency surgery patients between hospitals has been linked to higher mortality, but its impact on outcomes in the geriatric population is uncertain. This study in Surgery aimed to explore the effect of transfer between hospitals on postoperative outcomes in older people who have emergency general surgery. The authors concluded that transferring patients between hospitals contributed to overall mortality and morbidity amongst geriatric emergency general surgery patients. They call for further investigation into improved coordination between hospitals, tailored care plans and comprehensive risk assessments, to help improve outcomes for older emergency surgery patients.
  8. News Article
    The NHS is engulfed in a summer crisis, senior doctors have said, amid severe ambulance delays, corridors crowded with trolleys and patients facing 25-hour waits in A&E units. The Royal College of Emergency Medicine (RCEM) sounded the alarm over the “national scandal” of long waits for emergency care that it said were leading to “entirely preventable” deaths at a time of the year when there should be some respite from the traditional pressure experienced over winter. Elderly people in particular were facing the brunt of the impact, with many forced to endure horrific long waits for a bed once a decision had been taken to admit them to hospital, the college said. A snapshot survey by the RCEM of emergency department chiefs from across the UK, conducted between Monday and Wednesday this week, exposed the extent of the summer crisis in hospitals. Nine in 10 (91%) of 63 A&E bosses admitted NHS patients were “coming into harm” on their wards due to the quality of care that could be delivered under current conditions. Eighty-seven per cent said they had patients being treated in corridors and 68% said they had patients waiting in ambulances outside their A&E. One emergency department leader revealed that one of their patients this week waited more than 19 hours for a hospital bed to become available once a decision was made to admit them after they had already waited six hours to be seen. Overall, the patient ended up waiting 25 hours in A&E. Read full story Source: The Guardian, 20 June 2024 Related reading on the hub: A silent safety scandal: A nurse’s first-hand account of a corridor nursing shift Reflections on a clinical shift: "After 20 years of nursing, this is one of the worst shifts I have ever completed"
  9. Content Article
     Results of Age UK’s research into the experience of people aged 50 and over accessing health and social care services. This research into older people’s experiences of health and care services has revealed the extent of the challenges they face in accessing and receiving them. These challenges are confronted at a time in their lives when people are likely to be most reliant on such services to keep them well, independent, connected and safe. People from across the age spectrum, from 50 to over 100 years old, told Age UK about difficulties in accessing primary care services, including GPs and dentists. Health problems that could have been quickly and easily resolved have worsened through long waits for appointments and treatment. In some cases, older people have given up seeking treatment and care as they had lost hope of being able to see a clinician at all. For those of working age the problems in accessing appointments, referrals and treatment have had an impact on their ability to maintain good health, to remain in work and to care for others. Lack of access to support for carers has led to deteriorations in their physical and mental health.
  10. News Article
    Millions of people over the age of 50 in the UK have concerns about struggling to access healthcare, according to new analysis by Age UK. It comes as one elderly and disabled patient admitted he cannot afford to wait on hold to his GP practice for an appointment for long due to rising phone bill costs. A new report by Age UK – It’s a Struggle to be Seen – analysed the results of a representative poll, conducted for the charity by Kantar, of 2,621 UK adults over 50, as well as its own online survey which attracted more than 17,000 responses. The report claims less than half (48%) of people over 50 are confident their medical issue would be solved by NHS services. Some 49% – which Age UK equates to 12.6 million people – were concerned about their ability to access their GP, while 42% were worried about access to hospital appointments. The same proportion expressed concerns about access to emergency departments, the charity said. Caroline Abrahams, charity director at Age UK, said: “Sadly, for some older people, healthcare delayed means healthcare denied, because they do not have time on their side. “Our new analysis highlights just how many are being subjected to distress and, in some cases, enduring pain, because of their difficulties in accessing the GP services that they need.” Read full story Source: Medscape. 17 June 2024
  11. Content Article
    Falls are reported by more than 14 million US adults aged 65 years or older annually and can result in substantial morbidity, mortality, and health care expenditures. This study reviewed interventions to reduce falls.
  12. Content Article
    This study explored the beliefs and organisational contexts of nursing aide (caregivers henceforth) assaults and their subsequent reporting of these events. Although this data is a pretty specific cohort and setting (rural nursing homes), the social and systems lenses that the authors take, and the silence resulting from blame attributions have broader applications.
  13. News Article
    People aged 65 and over arriving at A&E in England who appear frail will soon receive a “health MOT at the front door”, the head of the NHS will pledge. A&E units must start giving everyone that age a battery of tests to see if they are frail or have any other underlying condition and then arrange whatever care they may need. NHS England hopes the initiative will reduce the number of older people being admitted to hospital, and cut overcrowding, “trolley waits” and “corridor care”. Amanda Pritchard, the organisation’s chief executive, will tell an audience of health service heads on Wednesday they must ensure by next April that all A&E units start offering detailed assessments of older people’s health. However, the service will only operate for 10 hours a day. “Health MOTs at the front door of A&Es for older people could be a lifeline for many. From blood pressure tests to a review of their falls history, these checks mean patients can be assessed quickly and directed to the right support for their needs,” Pritchard will say. “While some people do need to be admitted, it isn’t always the most suitable place for older patients’ needs, and they can also rapidly lose mobility while in hospital.” Read full story Source: The Guardian, 12 June 2024
  14. Event
    Safe and appropriate use of medicines in an ageing population is a complex balance between managing disease and avoiding medication-related problems. As the population ages, more Australians are living with multiple chronic diseases and may take multiple medicines, which is known as polypharmacy. This puts them at increased risk of medicine-related problems. Optimal medication management in older people requires a team-based approach to ensure the best quality of life. NMS 2024 will bring together leading organisations, experts, clinicians, consumers and policymakers within the aged care sector for a timely discussion on emerging and key issues around medicine safety in older people and will have a strong focus on highlighting practical ideas and initiatives that could be incorporated to improve the safe and quality use of medicines in an ageing population. Further information
  15. Content Article
    Reducing social inequalities in health and health determinants, including physical activity (PA), is a major challenge for public health. PA-promoting interventions are increasingly implemented. Little is known, however, about the impact of these interventions on social inequalities. For prioritising interventions most likely to be effective in reducing inequalities, studies of PA interventions need to conduct equity impact assessments. The aim of this article is to describe the development of a logic model framework for equity impact assessments of interventions to promote PA. The framework was developed within the prevention research network AEQUIPA—Physical activity and health equity: primary prevention for healthy ageing, informed by an equity-focused systematic review, expert interviews, exploratory literature searches, and joint discussions within the network. The framework comprises a general equity-focused logic model to be adapted to specific interventions. The intervention-specific equity-focused logic models illustrate the key elements relevant for assessing social inequalities in study participation, compliance with and acceptance of interventions, as well as the efficacy of interventions. Equity impact assessments are beneficial for prioritising interventions most likely to be effective in reducing health inequalities.
  16. Content Article
    This blog is part of a series written by Dr Charlie*, taking a closer look at some of the patient safety issues affecting people lives today. In this blog Dr Charlie tells us how their elderly mother was met with multiple digital barriers when trying to access her medications. Describing the situation as a frustrating goose-chase, Dr Charlie summarises the blog by questioning what measures are put in place to safeguard patients during digital transformations.  *not the authors real name
  17. Content Article
    This US cross-sectional study in JAMA Network Open aimed to find out whether there is a difference in reported inappropriate antipsychotic medication use between severely and less severely deprived neighbourhoods, and whether this difference is modified by greater total nurse staffing hours. The study included 10,966 nursing homes and found that nursing homes that fell below critical levels of staffing (less than three hours of nurse staffing per resident-day), were associated with higher inappropriate antipsychotic medication use among nursing homes in severely deprived neighbourhoods (19.2%) compared with nursing homes in less deprived neighbourhoods (17.1%). These findings suggest that addressing staffing deficiencies in nursing homes, particularly those located in severely deprived neighbourhoods, is crucial in mitigating inappropriate antipsychotic medication use.
  18. News Article
    A recent analysis found poor survival rates after bone fractures in older adults, with fewer than a third of men and half of women surviving five years after a fracture. Published in JBMR Plus, the study looked at a cohort of 98,474 Ontario residents age 66 and older who suffered fractures to parts of the body associated with osteoporosis between January 2011 and March 2015. The patients were grouped into sets based on the fracture site and matched to patients with a similar demographic profile but no bone breaks during the study period. The fracture cohort was mostly female (73 percent), and the median age at fracture was 80. In the year before the fracture, up to 45 percent of the women and 14 percent of the men had been treated for osteoporosis. The analysis revealed that those within a year of a hip, vertebral or proximal non-hip, non-vertebral fracture were at the highest risk of death. The survival probability was lower for the oldest patients. “Survival most dramatically declined within one month after most types of fracture, with a five-year survival being similar to or worse than some common cancers,” the paper’s lead author, Laval University department of medicine professor Jacques Brown, said Read full story (paywalled) Source: Washington Post, 12 May 2024
  19. Content Article
    This French cohort study in JAMA Internal Medicine aimed to find out whether spending a night in the emergency department (ED) associated with increased in-hospital mortality and morbidity among older patients. The results showed that older patients who spent a night in the ED showed a higher in-hospital mortality rate and increased risk of adverse events compared with patients admitted to a ward before midnight. This finding was particularly notable among patients with limited autonomy.
  20. News Article
    A gran was left lying outside in the cold facing a seven hour wait for an ambulance following a fall before finally being rescued — by firefighters. Betsy Hulme, 83, was left in agony with a broken hip when she tumbled in her back garden in Leek, Staffordshire. Son Steve, 60, a former ambulance technician, dialled 999 only to be told it would be several hours until paramedics could get to them due to long handover delays. After a further three hours of Betsy waiting on cold concrete slabs while soaked in rain water, desperate Steve decided to drive to a nearby fire station to ask for help. Fire crews then came to rescue to lift gran-of-four Betsy into her son's car who took her to hospital where she remains after undergoing a hip repair operation. Dad-of-two Steve, of Leek, has now branded emergency response times as “absolutely disgusting”. He said: "It’s opened my eyes if I’m honest. It’s absolutely disgusting. I’m so grateful and thankful to the fire service - but it really isn’t their job. I can't remember in my time working as an ambulance technician going to someone and saying, 'I’m sorry it’s taken us twelve hours to get here'." “It was never anywhere near those ridiculous times when I worked there until 2000 and something has gone drastically wrong since. I can't speak highly enough of the boys and girls who work in the NHS, it's the people above them. Its systemic change that's needed." Read full story Source: Wales Online, 4 April 2024
  21. News Article
    Older people are routinely enduring hidden waits of several months to get essential care and support, according to new figures obtained from government. Waiting time figures for adult social care are not routinely published in England, but last summer the Department of Health and Social Care collected the information from councils for the first time in at least a decade. They have been released to HSJ after a freedom of information appeal, and show average waits of up to 149 days (about five months) in Bath and North East Somerset, with 25 councils (30% of the 85 councils which supplied this information) reporting waits of two months or more. Some people will be waiting much longer than the averages reported. Across the 85 councils which reported average waits, the average of those figures was around 50 days. But the figures released to HSJ show huge variation – with three councils reporting waits of less than 10 days – although this is partly due to recording differences. The lack of clear figures, and absence of national waiting time measures and standards for adult social care, in contrast to the many targets and published figures in the NHS, and has sparked calls for that to be changed. Sir David Pearson, a former integrated care system chair and director of adult social care, who led the government’s Covid-19 care taskforce in the wake of the disaster in care homes in spring 2020, said: “One way of ensuring public confidence is a timely response to need. “Being clearer about a small number of standards and measures would help to achieve this. Of course it has to be associated with the right funding and reform, including supporting the social care workforce”. Read full story (paywalled) Source: HSJ, 25 March 2024
  22. News Article
    The Royal College of Paediatrics and Child Health has called on the UK government not to wait until after the upcoming general election to approve an infant immunisation programme against respiratory syncytial virus (RSV), so that babies can be protected next winter. In June 2023 the Joint Committee on Vaccinations and Immunisations (JCVI) recommended developing an RSV immunisation programme for infants and for older adults.1 It issued a fuller statement reiterating the advice in September 2023.2 But the government has yet to make a final decision on rolling out an RSV immunisation programme. A letter signed by more than 2000 paediatricians and healthcare professionals says that the sooner a full RSV vaccination programme is implemented the more effective it will be and that it “could save child health services reaching breaking point.” Read full story (paywalled) Source: BMJ, 20 March 2024
  23. Content Article
    Older people’s mental health has long been overlooked and poor mental health is often dismissed by health professionals as an ‘inevitable’ part of getting older. And despite NHS Talking Therapies having higher than average recovery rates among the over-65s, this service is less likely to be offered to older people. Commissioned by Age UK, this briefing from the Centre for Mental Health summarises evidence about the mental health of older people in England. It finds that ageist attitudes underpin a system that discriminates against older people, while fatalistic assumptions about what people can expect for their mental health in later life undermine the provision of effective support to promote wellbeing, prevent mental ill health and treat mental health difficulties. The briefing finds that while older people may possess many protective factors for good mental health, they face numerous risk factors, including poorer physical health, reduced mobility and, for some, poverty and racism. Tackling the risk factors and boosting protective factors can increase wellbeing in later life and either prevent or stop the escalation of mental health problems.
  24. News Article
    Doctors made do-not-resuscitate orders for elderly and disabled patients during the pandemic without the knowledge of their families, breaching their human rights, a parliamentary watchdog has said. In a new report on breaches of the orders during the pandemic, the Parliamentary Health Service Ombudsman (PHSO) found failings from at least 13 patient complaints. The research, carried out with the charity Dignity in Dying, found “unacceptable” failures in how end-of-life care conversations are held, and in particular with elderly and disabled patients. Following a review of complaints in 2019 and 2020 the PHSO found evidence in some cases that doctors did not even inform the patient or their family that a notice had been made and so breached their human rights. The report calls for health services in Britain to improve the approach by medics in talking about death and end-of-life care. In examples of cases reviewed, the PHSO revealed the story of 58-year-old Sonia Deleon who had schizophrenia and learning disabilities and a notice which was wrongly applied during the pandemic. In 2020, she was admitted to Southend University Hospital after contracting Covid-19 at age 58. On three occasions a notice was made but her family were never informed. Following Sonia’s death her family found out the reasons given by doctors for the DNAR which “included frailty, having a learning disability, poor physiological reserve, schizophrenia and being dependent for daily activities.” Sonia’s sister Sally-Rose Cyrille said: “I was devastated, shocked and angry. The fact that multiple notices had been placed in Sone’s file without consultation with us, without our knowledge, it was like being hit with a sledgehammer. Read full story Source: The Independent, 14 March 2024
  25. Content Article
    A change in how British people and health professionals talk about death is needed to avoid delays in crucial conversations about end-of-life care, resulting in traumatic consequences for patients and their families, the Parliamentary and Health Service Ombudsman (PHSO) has warned. In a new report, End of life care: improving ‘do not attempt CPR’ conversations for everyone, PHSO has called for urgent improvements to the process and communication surrounding do not attempt cardiopulmonary resuscitation (DNACPR), so doctors, patients, and their loved ones can make informed choices about their care.
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