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About the BGS

The British Geriatrics Society is the professional body of specialist doctors, nurses, therapists and other professionals concerned with the health care of older people in the United Kingdom.

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January 2018 Newsletter

The January issue of the BGS newsletter is available:

Highlights - Payment by Results HRG4+ Grouper
Dip the urinalysis test strips in the bin
2017 Autumn meeting conference report

Call for Abstracts

Call for Abstracts for the BGS 2018 Autumn Meeting to be held in London in November 2018. The submissions facility closes at 17:00 on 15 June.

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Age & Ageing Journal

Age and Ageing  is the British Geriatrics Society’s international scientific journal. It publishes refereed original articles and commissioned reviews on geriatric medicine and gerontology.

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In memoriam: Sir John Grimley-Evans (1936 – 2018)

It is with regret that the BGS reports that on 26th March 2018, Sir John Grimley-Evans, Emeritus Professor of Clinical Geratology at Oxford University and luminary of geriatric medicine passed away. 

Links to Sir John's reflections on editing the Age and Ageing journal and a short biography on his time as editor of the journal.

The Times has published an obituary, leading on Sir John's medical examination (at the behest of the Home Secretary) of General Pinochet, the former Chilean dictator, to determine whether he fit enough to be extradited to Spain to stand trial on torture charges. (This report is behind The Times's paywall).

 

Patients with multiple conditions not getting best possible care, say experts

Reported in The Guardian (19 April 2018): Too often patients are treated by a raft of different specialists when they should be treated more holistically

Millions of people in the UK and many more across the world are suffering from multiple long-term illnesses and may not be getting the best possible treatment from health services that focus on one disease at a time, say experts.

A team from the Academy of Medical Sciences in the UK says this is a growing problem and a huge potential burden on the NHS and other health services. “Clusters” of diseases are becoming more common, they say, such as type 2 diabetes, high blood pressure, osteoarthritis, depression and chronic obstructive pulmonary disease of the lungs.

Specialised hospital doctors treat each one of these conditions individually. Patients may have one problem treated and then have to wait months to see a different specialist for another condition. The experts are calling for a greater role for the GP, who can look at the whole person, but needs more time than a 10 minute consultation.

Prof Stephen MacMahon, principal director of the George Institute for Global Health and chair of the Academy’s steering group on multimorbidity said the best evidence on the numbers came from Australia, but there was no reason to think other countries would be different. “Among Australians seeing a general practitioner, half have two diseases or more, a third have three or more and 10% have six diseases or more,” he said. “This is not a small problem.”

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The Clinical Trial Is Open. The Elderly Need Not Apply

The New York Times (13 April 2018): 

Geriatricians have complained for years that figuring out treatments for their patients becomes dramatically more difficult when older people are excluded from clinical trials and other research.

For an 83-year-old, what are the risks and benefits of a surgical procedure, drug or medical device tested primarily on those in their 50s? When a drug trial excludes those who have several diseases and take other drugs, how do the results pertain to older adults — most of whom have several diseases and take other drugs?

Too often, doctors resort to extrapolation — or, to put it less politely, guessing.

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Apply now for BGS Support with EAMA fees

The European Academy for Medicine of Ageing (EAMA):  Advanced Postgraduate Course 2019-20

The European Academy for Medicine of Ageing is an Advanced Postgraduate Course in Geriatrics.

The EAMA’s goals are to:

  • Improve knowledge and skills in geriatric medicine for junior faculty members and promising candidates for future teachers in geriatrics
  • Attune the attitudes and goals of future opinion leaders in geriatric medicine throughout Europe
  • Establish a network among medical doctors responsible for the care of elderly persons and those responsible for student instruction
  • Develop new ideas for geriatric health programmes and harmonise practices
  • Encourage scientific interest in gerontology and geriatrics at local, national and international levels.

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2018 End of Life Care

The powerpoint files supporting presentations at the BGS 2018 End of Life Care conference are now available for download. We publish only those files which have been authorised for publication by the authors. The files are published in secured pdf format to obviate plagiarism as far as this is possible. (updated 28 March 2018)

Adrian Hopper: AMBER Care Bundle

Adrian Treloar: Joined up care; lessons for dementia

Dawn Moody: Using population sub-segmentation to promote tailored end of life care in later life

Caroline Nicholson: Attending to living and dying: improving end of life care for older people with frailty in the community

Sustainability and transformation in the NHS Contents

The Department of Health and Social Care (the Department) is ultimately responsible for securing value for money from healthcare services. It sets objectives for the NHS through an annual mandate to NHS England and in 2016–17 gave it £105.7 billion to plan and pay for services and patient care delivered by the NHS. NHS England allocated the greatest share of this budget to 209 clinical commissioning groups, which largely bought healthcare from 235 hospital, community and mental health trusts. Trusts manage their expenditure against the income they receive, while NHS Improvement oversees and monitors the performance of trusts. The Department has made NHS England and NHS Improvement responsible for ensuring the NHS balances its budget.

In 2016–17, NHS England, clinical commissioning groups and NHS trusts and NHS foundation trusts (trusts) reported a combined surplus of £111 million against their income, a significant improvement compared to the combined deficit of £1,848 million they reported in 2015–16. This improvement was the direct result of the Department’s £1.8 billion Sustainability and Transformation Fund, paid by NHS Improvement to trusts for meeting financial and performance targets. Without this Fund, the combined financial position of the NHS would have been only slightly better than in 2015–16. As well as balancing its books each year, the NHS needs to invest in new ways of working that can better serve the changing needs of patients and increasing demand for services. To facilitate a more long-term approach to achieving sustainability, local partnerships of commissioners, trusts and local authorities have been set up to develop long-term strategic plans and transform the way services are provided more quickly.

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House of Commons Select Committee Inquiry into the right to freedom and safety: reform of deprivation of liberty safeguards

 

Submission by the BGS February 2018: The British Geriatrics Society’s view is that the current deprivation of liberty safeguards (DoLS) are unfit for purpose and should be replaced by the proposed new system of ‘protective care’, instead of ‘restrictive care’. We would like Government to proceed with implementation and for a definition of deprivation of liberty for care and treatment to be debated in Parliament and written into statute.

Introduction

1. The British Geriatrics Society (BGS) is the professional body of specialists in the healthcare of older people in the United Kingdom. Our membership is drawn from doctors practising geriatric medicine including consultants, doctors in training and general practitioners, nurses, allied health professionals, researchers and scientists with a particular interest in the care of older people and the promotion of better health in old age. BGS has 3,500 members who work across England, Scotland, Wales and Northern Ireland.

2. In 2015 BGS responded to the Law Commission’s consultation on reform. We fully agree that the current deprivation of liberty safeguards (DOLS) are unfit for purpose and should be replaced by a new system of protective care instead of restrictive care. We were pleased to see this acknowledged in the Law Commission’s final report and Government’s interim response to it. Our full and detailed response to the 2015 consultation is available here.

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Struggling to cope

Age UK warns of the risks of getting into a self-destructive rut as we age, with widespread ageism being a big part of the problem.

Approaching one and a half million over 65s feel they don’t have control of their lives and almost a million say that life rarely or never has any meaning for them

New analysis from Age UK shows that almost one and half million over 65s (1.465m) feel that what happens in their life is determined by factors beyond their control; and almost a million (936,642) say that their life rarely or never has any meaning. These feelings are more prevalent among the oldest age groups, with nearly 1 in 6 over 85s thinking their life rarely or never has meaning, compared to 1 in 10 aged 55-65. [i]

The charity is therefore calling on everyone to do more to support older people in recognising their self-worth, as well as calling on older people themselves to try to take steps to avoid getting into a self-destructive rut, from which it can be extremely difficult to escape.

A new Age UK report, ‘Struggling to Cope with Later Life’, explores these issues in greater depth and includes a checklist of top tips for older people and those around them, on how to avoid getting dragged down as they age, and how to get to a better place again if this happens.

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House of Commons Joint Inquiry by Communities and Local Govt, and Health Select Committees, on long-term funding of adult social care

Submission by the British Geriatrics Society (March 2018): 

Executive Summary

The British Geriatrics Society believes that the current divide between health and social care budgets must be addressed, and a funding mechanism based on need is key as part of any long term funding solution. Below we set out some of the key features that we believe would support a sustainable funding model that enables all older people to receive high quality, patient-centred care when and where they need it.

Introduction

1. The British Geriatrics Society (BGS) is the professional body of specialists in the healthcare of older people in the United Kingdom. Our membership is drawn from doctors practising geriatric medicine including consultants, doctors in training and general practitioners, nurses, allied health professionals, researchers and scientists with a particular interest in the care of older people and the promotion of better health in old age. BGS has 3,500 members who work across England, Scotland, Wales and Northern Ireland.

2. BGS welcomes this opportunity to present a written submission to the Committee’s Inquiry into the long term funding of adult social care.

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New guidelines for recognising and assessing pain in older adults

BGS, London (20 March 2018): New recommendations to help healthcare professionals recognise and assess levels of pain in older people were published today in the scientific journal Age and Ageing. The guidelines were developed by the British Geriatrics Society, the British Pain Society, the Royal College of Nursing, in collaboration with researchers at Teesside University, Anglia Ruskin University, University of Bournemouth, Centre for Ageing Better, and the Centre for Positive Ageing.

There is growing evidence to demonstrate that chronic pain is more prevalent among the older population and pain that interferes with everyday activities increases with age. Alleviating pain in the older population is therefore a priority but presents a number of challenges, especially in relation to communication with patients. These guidelines seek to address specific areas in which improvements can be made. To support this aim all existing publications on acute and chronic pain screening and assessment in adults over 60 years of age were identified, and two reviewers independently read and graded the papers according to the National Health and Medical Research Council criteria (1999b).

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National Audit Office report on reducing emergency admissions

Download the full report

Background to the report

NHS England defines an emergency admission to be “when admission is unpredictable and at short notice because of clinical need”. Some emergency admissions are clinically appropriate and unavoidable. Others could be avoided by providing alternative forms of urgent care, or by providing appropriate care and support earlier to prevent a person becoming unwell enough to require an emergency admission.

The Department of Health & Social Care sets NHS England’s mandate for arranging the provision of health services. The 2017-18 mandate includes an objective for NHS England to achieve a measurable reduction in emergency admission rates by 2020.

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Palliative care provisions are not meeting the needs of an ageing population

BGS, London (7 March 2018): A commentary published today in Age and Ageing, the scientific journal of the British Geriatrics Society, warns despite the fact that frail older people with multiple illnesses and end stage dementia are the most rapidly growing group in need of palliative care current provisions are not aligned to meet their needs.

The authors of the commentary noted that current projections indicate that between 25% and 47% more people may need palliative care by 2040 in England and Wales. A high proportion of these people will die following a prolonged period of increasing frailty and co-morbidity including cancer, but also other long-term conditions such as heart failure, chronic obstructive pulmonary disease, diabetes or renal failure.

Current palliative care provisions were initially developed during the hospice movement in the 1960s which transformed the philosophy of care and experience of dying for patients and families affected by cancer. The goal was to provide holistic care, excellent control of symptoms and enhancement of quality of life until the end. This philosophy of palliative care, alongside core cultural values of autonomy and choice, has shaped prevailing policy and professional constructs of ‘the good death’. The authors highlighted the fact that for many older patients current palliative care provisions do not align with their needs as these provisions rely on clearly identifiable and relatively short terminal disease trajectories.

The authors concluded that there is an urgent need to restructure and provide additional funding for palliative care in community care settings to accommodate the changing needs of an ageing population. The prolongation of dying creates enormous new challenges and reduces the possibility of dying at home, especially for those who live alone.

Kristian Pollock, co-author of the commentary and a Principal Research Fellow at the University of Nottingham, commented:

"We are pleased to have worked with Age and Ageing and colleagues in the USA to bring to greater attention the need to adapt palliative care services to the growing needs of older people with frailty and dementia: this is one of the biggest public health challenges globally."

Read the Age and Ageing commentary ‘Reappraising ‘the good death’ for populations in the age of ageing’.

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