Older People Whisperer: The quest to become a geriatrician
Welcome to our first newsletter of 2017, following a year of many ups and downs!
Most of us faced financial challenges and despite rising demand for our services we find ourselves ever more stretched. I say this as one who recently lost a local service; there is no doubt that even tougher times are ahead. The BGS continues to advocate for older people in this climate: take a look at the first press release from President Eileen Burns, on delayed transfers of care. The person at the centre of this situation must not be blamed and Dr Burns calls on the government to understand this and ensure that social care is adequately funded.
NHS Scotland’s vision for 2020 is that we will “live longer healthier lives at home”.
With continuing advances in technology and medicine, and a greater understanding of how diet and good social care affects quality of life, it is anticipated that by 2037 there will be an 83 per cent increase in the 75+ population to 779, 000. Today this stands at 425,000 and already poses challenges to our health services and social services, owing to the fact that people living longer often have complex health problems and multiple co-morbidities. It is hard to imagine that at the beginning of the last century, people often died before 50 years of age. We have become victims of our own success and the budget for the NHS has been described as a bottomless pit!
This is my first column as President of the British Geriatrics Society, so I want to start by saying how honoured and thrilled I am to take on the office.
I start in the role, conscious of the great work done by previous presidents (most recently, of course, the indefatigable David Oliver) and with an awareness of the size of the shoes I have to fill! I promise that I’ll learn from my predecessors and take forward the work of the Society to the absolute best of my ability. David, as those who know him would expect, has not retired to a spot of gardening or relaxation at home, he’s now clinical Vice president at the Royal College of Physicians of London. Whilst his role there is clearly multi-specialty, we rely on him to continue keeping our interests close to his heart! David’s enormous knowledge of those in the Health and Social care policy world was of great benefit to the Society, and we trust that he will continue to be a valued resource.
Substance misuse is on the rise in older adults due to an ageing population and ‘the baby boomers’9 approaching older adulthood. It is estimated that substance misuse will double between 2001 and 2020 in adults over 65 and is related to increased mortality and morbidity. 1, 3
Substances misuse ranges from the harmful use of alcohol, tobacco, and illicit drugs to prescribed and over the counter medication. Older people are more vulnerable to harmful effects of substance misuse due to the physiological changes associated with ageing, polypharmacy and co-morbid illnesses as well as the direct impact on physical health due to poor diet, isolation and poverty.1 Healthcare professionals may be uncomfortable asking about substance misuse in older people and the information may not be disclosed by patients or carers but certain symptoms should trigger screening for substance misuse especially as they can be easily attributed to ageing or an early dementia1 (see box 1). Risk factors for substance misuse can include loneliness, retirement, isolation, bereavement or an underlying depression, anxiety or cognitive disorder.
Reflections on a recently published article in Age and Ageing by Clague et al. (2016)
Populations are ageing across the world, leading to growing numbers of people surviving to develop dementia, many of whom will have complex care needs.
“Today, 47 million people live with dementia worldwide, more than the population of Spain. This number is projected to increase to more than 131 million by 2050, as populations age. Dementia also has a huge economic impact. The total estimated worldwide cost of dementia is US$818 billion, and it will become a trillion dollar disease by 2018.” World Alzheimer Report 2016, Alzheimer’s Disease International
Twenty first century specialist medical care for older people will not be confined within the walls of a hospital: much of it will be delivered in or close to the patient’s home.
This glimpse into the future – with examples of how it is already happening in the present – was the major theme of the first day of the BGS Autumn meeting in Glasgow.
The Hospital At Home Forum – the first ever UK wide one – was run by the Society’s Community Geriatrics Special Interest Group and focused both on the push factors – increasing demand, stretched resources and the unsuitability of many aspects of hospitalisation for frail older people – and the pull ones – innovative technology, clinical effectiveness and patient satisfaction.
An ageing population has led to an increasing prevalence of dementia disorders, putting pressure on health care systems to develop efficient strategies for diagnosis and care.
In many care systems, this has meant shifting some of the diagnostic burden onto primary care physicians.
The Swedish Dementia Registry, SveDem, is a nationwide quality registry founded in 2007 with a view to improving quality and equality of dementia care throughout the country. Patients are registered with SveDem at the time of dementia diagnosis, together with information on demographic background, living situation, cognitive level and medication.
During autumn there were some good opportunities to promote BGS’s work and key messages to a range of opinion formers and decision makers. I am also very much enjoying working with BGS officers and colleagues, and getting to know BGS members, as well as policy colleagues in some of the other organisations that we work with.
Key policy developments and current programme of work
BGS’s written submission to the House of Lords Select Committee Inquiry on the long-term sustainability of the NHS.
Marina Mello, BGS Communications Manager spoke to Susan Stefiuk, who was recently awarded the BGS Special Medal for ‘work to promote the health and wellbeing of older people throughout society’. Susan is a Senior Coordinator for Well Being and Friendship Services at Age UK. She has been the lead in developing Age UK’s well-being services for over seven years. During that time she developed a wide variety of new services and activities to keep older people fit and active.
Dr Pat McCaffrey is the Clinical Director for Older People and Stroke Medicine within the Southern Trust in Northern Ireland. She is an active member of the British Geriatrics Society and is currently the Northern Ireland representative on the BGS Policy and Communications Committee. She sits on the steering group for the stroke improvement program and has continuously sought to improve the care for older people within Northern Ireland.