Presentation slides: BGS Spring Meeting 2019

John Gladman is a professor in the medicine of older people in Nottingham and has wide experience both as a geriatrician in many different parts of clinical services, and as an academic using a wide range of methods and addressing a wide range of topics across translational, applied and implementation research.

Speaker abstract

Frailty is a useful but still under-developed concept, which we should use carefully and continue to develop theoretically One important development is to switch the focus from the negative concept of frailty to a positive one such as resilience Doing so might help us work more constructively with our patients

Living through an episode of delirium

Mr Phillip Hall, Senior nurse for dementia, University Hospitals Birmingham NHS Foundation Trust

"• ‘I thought killing myself was the only way out’- a first person perspective on the experience of delirium

• The experience and outcomes of delirium, extreme distress and never going home"

Dr Carolyn Greig PhD FPhysiol is a Reader in Musculoskeletal Ageing and Health at the University of Birmingham, based in the School of Sport, Exercise and Rehabilitation Sciences. She co-leads the interventions theme for the MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research (CMAR). In addition she is a member of the UK physical activity guidelines older adults working group. Carolyn is a translational scientist with a longstanding research interest in the design and conduct of studies to maximise the responsiveness of older muscle to physical activity, exercise training and nutritional supplementation, either as single or combined intervention regimens. Her research countering age related loss of muscle mass and function (sarcopenia) and frailty includes diverse groups of older adults, from healthy independent living to frail patient groups.

Speaker abstract

• Does increasing physical activity via exercise combat sarcopenia?
• Can we influence sarcopenia by reducing physical inactivity (through sitting less)?
• What’s the latest on the evidence base for combining resistance exercise with nutritional supplementation, in terms of countering sarcopenia and frailty?"

Dr Alison Dawson is an applied sociologist, Research Fellow in the University of Stirling’s Faculty of Social Sciences, and deputy chair of its Dementia and Ageing Research Group. Her research focuses on examining and evaluating policies and practices and developing novel interventions aimed at supporting and/or improving the wellbeing of vulnerable older people in different contexts. Current research interests include the role of technology in providing support for older people, time use in unpaid care/ support, promoting movement and activity in care homes, and the role of building design in supporting people with dementia.

Speaker abstract

Session aims:

• Provide attendees with a brief overview of recent research evidence on the benefits of physical activity for older people with dementia or cognitive impairment
• Use a recent study by the University of Stirling to illustrate and discuss key issues in conducting research in care homes
• Introduce CHARMS (Care Homes Achieving Realistic Movement Strategies), an evidence-based approach that can be used by care homes to increase opportunities for and promote movement and activity for residents

Prior to joining Erskine in June 2016, Derek worked in NHS Greater Glasgow & Clyde, NHS Orkney and NHS Ayrshire & Arran. Latterly he was Lead Nurse/ Associate Nurse Director in North Ayrshire Health and Social Care Partnership. Derek is also a Visiting Senior Lecturer, University of Abertay, on the Nursing and Midwifery Council Professional Strategic Advisory Group and on the Editorial Board of the British Journal of Mental Health Nursing.

Chris is a cardiology registrar. He put his clinical training ‘on pause' to pursue a Master’s in Public Health, and is currently working towards an MD in cardiovascular epidemiology. He is interested in using observational data to improve patient outcomes through identifying unwarranted variation in care. He is currently investigating the impact of frailty on clinical outcomes for older people with atrial fibrillation. Chris is a clinical lecturer in cardiology at York Hospital, and an MD student at the University of Leeds.

Speaker abstract

Atrial fibrillation is common in older people, who frequently have co-existing frailty. However, there is surprisingly little evidence to guide clinical decision making, particularly with regard to anti-coagulation. This session with include a brief summary of the current evidence to guide anticoagulation decisions in this vulnerable population, followed by a discussion of some of the challenges and opportunities in using large observational datasets to research this.

Ronan Lyons, FFPH, MD, FLSW is Professor of Public Health at Swansea University, Director of the National Centre for Population Health and Wellbeing Research and Director of the Wales and Northern Ireland site for HDRUK UK. He pioneered the development of privacy-protecting whole of population electronic cohorts. His wide-ranging research interests include the influences of wider determinants on health and wellbeing through the lifecourse, the role of the build environment and the evaluation of natural experiments. He also leads the analysis platform for the MRC Dementias Platform UK (DPUK) initiative, providing global remote access to more than 30 cohorts.

Speaker abstract

This session will focus on:

• Developments in data linkage and availability of data across the UK
• Opportunities for the evaluation of cross-sectoral interventions
• New approaches to data analysis

Dr Vilches-Moraga is a consultant at Salford Royal NHS Foundation Trust. Arturo is a working geriatrician with an interest in POPS-GS (proactive care of older people admitted to general surgery)

Speaker Abstract

Advanced age, frailty, polypharmacy and multimorbidity are the norm in older patients admitted to General Surgery. We will discuss how to provide Comprehensive Geriatric Assessment, patient centred targeted multidisciplinary interventions and timely discharge planning.

Dr Maggie Keeble works two days a week as a Care Home GP looking after 160 residents in five different homes. She has always had an interest in End of Life and Palliative Care and having done a Diploma in Palliative Care in 2012 decided to leave her GP practice to focus on the Care of Older People and in particular the area of Palliative and End of Life Care in Frailty. In addition she is Strategic Clinical Lead for Integrated Care for Older People in Worcestershire working to ensure collaboration between Older People and their supporters, Health, Social Care, Voluntary Care Sector, Housing and the leisure industry in the county.

Speaker Abstract

• The Similarities and Differences between End of Life and Pallative Care in Cancer vs Frailty
• How to recognise when adopting a Palliative approach would be appropriate
• How to start conversations with patients and family members Mental Capacity Act and End of Life Care
• Symptom Control and Anticipatory Prescribing for End of Life Care in Frailty
• Last days of Life Care in Frailty
• Death Certification following a Frailty Related Death hire

Chris Thomas is a Consultant Physician and Geriatrician in the Cardiff and Vale UHB and Honorary Lecturer for Cardiff University. He is the co-lead of the Parkinson’s team as well as the lead for the Elderly Care Assessment Service for half of the trust area. He also provides input into the Cardiff Memory Team. Dr Thomas is interested in teaching at undergraduate and postgraduate levels. He has spoken at a number of national educational meetings as well the Welsh National Assembly. He has published in a variety of peer-reviewed journals and has presented on Parkinson’s in a range of international conferences.

Speaker Abstract

• Service delivery – innovations and novelties in care
• Adopting technology into routine care
• Enhancing cross-specialty working

Sponsored Symposium from Abbott Nutrition

Muscle Matters: Preventing Muscle Loss – A Number One Priority for Improving Outcomes in the Elderly

Dr Adrian Hopper is a Geriatrician at Guy’s and St Thomas’  NHS Foundation Trust.  He has been Safety and Quality medical lead for GSTT  and the local AHSN where he had applied decision support to a range of clinical processes of which AMBERcarebundle is an example

Speaker Abstract

• Introduce AMBERcarebundle a checklist to improve reliability of clinical processes in patients with uncertain recovery
• AMBERcarebundle as an example of complex large scale change
• How to implement the AMBERcarebundle
• Impact and evaluation

Duncan qualified as a podiatrist in 1980 and has worked in diabetes foot care for the past 30 years. He has been involved in many aspects of diabetes foot care, from screening to the running of multidisciplinary clinics in acute care. Duncan serves as an Executive Committee Member (Scottish Representative) of the Foot in Diabetes UK (FDUK). In May 2018 he retired clinically but continues to work 2 days per week with the Scottish Government as National Diabetes Foot Coordinator for Scotland, Duncan formed the Scottish Diabetes Foot Action Group (SDFAG) with the remit of improving services and outcomes for people with diabetes across Scotland. The SDFAG are involved with various work streams such as the development of the Traffic Light System, inpatient campaigns such as CPR for Feet and the development of on line ulcer management systems and screening tools.

Speaker abstract

• How to Check Feet
• How to Protect feet
• How to Refer patient
• How to standardise pressure relief to save valuable budgets

This session will consider the advantages and disadvantages of using (i) data from cohorts and (ii) routinely collected data to address questions related to the health and healthcare of older people.

Lucy Lewis is a Health Education England (South) Consultant Practitioner Trainee specialising in Frailty and Older People. Lucy’s clinical interests include improving pathways for older people into, out of and within the acute hospital setting. Her Quality Improvement projects have included; Comprehensive Geriatric Assessment: From Acute to Community Setting, Delirium and the Intermediate Care Team and Think Frailty Following a Fall. Her PhD research focuses on the involvement of older people living with cancer in decision making regarding treatment and support. Lucy represents the BGS Nurse and Allied Health Professional Council on the Policy and Communications Committee.

Speaker Abstract

Carl Adams and Lucy Lewis will share their experiences and learning from their Quality Improvement work. This session will include the highs, lows, challenges and opportunities of leading Quality Improvement projects which will provide an insight into Quality Improvement from the perspective of an Allied Health professional and nurse.

Scott Brakenridge, MD, MSCS, FACS, is an Assistant Professor of Surgery & Anesthesiology at the University of Florida (Gainesville, FL, USA). Dr Brakenridge’s clinical interests include trauma surgery, acute care surgery and surgical critical care. This includes the comprehensive surgical care of severely injured trauma patients and patients with surgical sepsis, including their initial evaluation in the emergency department, the operative management of acute surgical issues and their subsequent supportive care in the intensive care unit. Dr Brakenridge is a primary investigator and core leader of the UF Sepsis and Critical Illness Research Center. His research focuses on clinical, translational and outcomes approaches to investigate chronic critical illness (CCI), and the persistent inflammation, immunosuppression and catabolism syndrome (PICS) after surgical sepsis or severe traumatic injury, which represent a rapidly growing phenotype of long-term morbidity and mortality among early survivors of critical illness, especially the “aged reproduction” and “healthy ageing”. He remains actively involved in several large international research projects, with a particular interest in the influence of the physical, social and economic environments on health.

Speaker Abstract

The burden of poor outcomes after sepsis has now shifted from early deaths from refractory MOF, to a new phenotype of chronic critical illness (CCI) with persistent low-grade organ dysfunction, progressive sarcopenia, disposition to long-term acute care and skilled nursing facilities, and dismal long-term outcomes. In many instances, previously functional individuals develop a new state of cognitive, physiologic and functional morbidities consistent with the frailty syndrome of the elderly. We describe this emerging phenotype of an acute, persistent, decline in health status after critical illness as ‘induced frailty’.

Chris Thomas is a Consultant Physician and Geriatrician in the Cardiff and Vale UHB and Honorary Lecturer for Cardiff University. He is the co-lead of the Parkinson’s team as well as the lead for the Elderly Care Assessment Service for half of the trust area. He also provides input into the Cardiff Memory Team. Dr Thomas is interested in teaching at undergraduate and postgraduate levels. He has spoken at a number of national educational meetings as well the Welsh National Assembly. He has published in a variety of peer-reviewed journals and has presented on Parkinson’s in a range of international conferences.

Speaker Abstract

• Service delivery – innovations and novelties in care
• Adopting technology into routine care
• Enhancing cross-specialty working

Dr Jordan Abdi is a foundation trainee at the Kings College Hospital Trust in London. He has been working with a team of researchers in the burgeoning field of socially assistive robots, and how the technology can be used to in clinical settings. Jordan has also worked with London City Hall, the European Commission, the G7 and the G20 global summits to help develop the future policy directions on issues including the rise of the robots and their impact on workers.

Speaker Abstract

This talk will take a look at the technology being developed in elderly healthcare, and what the future has in store

John is Deputy Medical Director (Transformation) at East Lancashire Hospitals NHS Trust, working across the health economy leading service improvement. He spent 12 months at the Institute for Healthcare Improvement (IHI) and Harvard University, and has worked in QI initiatives across the Department of Health, Royal Colleges, NHS NW, IHI and the Health Foundation. He played a major role in the development of AQuA as clinical lead, faculty and non-executive board member. John was appointed Clinical Lead for QI and Patient Safety at the Royal College of Physicians in 2017. He is a Health Foundation/IHI fellow and Q fellow.

Speaker Abstract

• Background of quality improvement
• Examples of current day practice from small projects to large scale system changes.
• Future direction of Quality Improvement, making it part of professional practice. East Lancashire Hospitals NHS Trust

Dr Inderpal Singh is a consultant geriatrician at Aneurin Bevan University Health Board, Wales and Honorary Senior Lecturer, Cardiff University. He is a TPD (IM Training) and working collaboratively with HEIW to enhance the educational experience of trainee doctors and implement Shape of Training. His research focuses on education, inpatient falls, osteoporosis and dementia. He has authored over 25 research papers, reviews and book chapters. He has been awarded with ABUHB “Leadership award” in 2014; ABUHB “Research for patient benefit award” in 2015; “NHS Wales award” in 2017 and “Excellence in Teaching award” by Cardiff University School of Medicine in 2019.

Speaker Abstract

• Hospitals pose a particular challenge for the supervision of frail older people, particularly those with dementia
• Quality improvement work and involvement of the wider teams to avoid the ‘First Fall’
• Are there any benefits in terms of length of stay, new care home placements, inpatient hip fracture and mortality after the intervention
• How might I redesign ward care to avoid inpatient falls and fractures?

John Appleby joined the Nuffield Trust as Director of Research and Chief Economist in 2016 following his position at the King’s Fund as Chief Economist, and senior lectureships in health economics at the Universities of East Anglia and Birmingham. After his masters in health economics at the University of York in 1980, he worked in the NHS for seven years in Birmingham and London.  John has published widely on a range of health care finance and economic issues in books, academic journals, reports, magazines and newspapers. He is a regular columnist for the British Medical Journal. As well as his post at the Nuffield Trust, John is a Visiting Professor at the Department of Economics, City University, London, and at the Institute of Global Innovations at Imperial College London. 

Speaker Abstract

Thirteen (caveated) reasons to spend more on the NHS Including the economist’s answer as to when enough is enough.