Deconditioning

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Hospital-Wide Comprehensive Geriatric Assessment

07 June 2018

A Nuffield Trust led collaboration is part of an NIHR-funded project to research acute hospital care for frail older people. The aim of the work is to inform NHS managers, clinicians, patients and the public about how best to organise hospital services for frail older people.

Clinical guidelines

CGA issues: mobility and balance

25 April 2016

Improving older people’s walking and balancing improves quality of life, reduces dependence on health and social care and prevents falls. This guide looks at the importance of taking a full history, assessing gait and balance, and referral to physiotherapy.

In a series

Good practice guide

CGA issues: urinary incontinence

11 February 2016

Bladder control problems are a common problem in older people and result from a variety of causes. Continence issues are an essential part of any Comprehensive Geriatric Assessment, and this guide examines the causes, assessment, management and treatments available.

In a series

Good practice guide

CGA issues: end of life care

04 April 2016

End of life care refers specifically to the last few days or hours of life, when maintenance of comfort and dignity, and avoidance of pain and distress take priority. Many of the principles of care at the end of life are shared with CGA.

In a series

Good practice guide

CGA issues: falls

04 April 2016

Often a key component of Comprehensive Geriatric Assessment in primary care, this guide examines step-by-step how to carry out a multifactorial risk assessment for falls.

In a series

Good practice guide

CGA issues: confusion and delirium

10 February 2016

The prevalence of delirium in the community is 1-2 per cent but this rises to 14 per cent in people over 85, and in nursing homes or post acute care settings, can be up to 60 per cent. This guide deals with risk factors, diagnosis and management of this condition.

In a series

Good practice guide

CGA issues: depression

10 February 2016

Dealing with the management of depression as part of Comprehensive Geriatric Assessment including the treatments to consider.

In a series

Good practice guide

Involving Social Services in CGA

04 February 2016

CGA needs to consider the impact of social factors on the health and wellbeing of individuals and vice versa. Here we look at working with Social Services and the differences in the four nations of the UK.

In a series

Good practice guide

Psychological components of CGA

04 February 2016

Depression among the over-65s is often under-recognised, so CGA is not complete without assessing mental health. The assessment conversation also offers an opportunity to identify cognitive dysfunction which may be a sign of dementia or delirium.

In a series

Good practice guide

The BGS toolkit for comprehensive geriatric assessment in primary care settings

04 February 2016

An introduction to CGA in primary care settings. This toolkit was developed by the British Geriatrics Society and has been endorsed by the ANCD for Older People and Integrated Person-Centred Care and by the Council of British Geriatrics Society, Scotland.

In a series

Good practice guide

The elements of the CGA process

04 February 2016

An overview of how Comprehensive Geriatric Assessment (CGA) is done in the primary care setting, and what to consider when conducting the assessment.

In a series

Good practice guide

Medication review in CGA

04 February 2016

Medication review is a core component of CGA. Older patients can have indications for multiple medications, some of which may be based on sound evidence, but others may do more harm than good. The evidence base for guideline based prescribing may not be so relevant to frail older people.

In a series

Good practice guide

Care and support planning in CGA

04 February 2016

A reference guide to care and support planning within Comprehensive Geriatric Assessment for primary care and community clinicians, including the recommended components and tips for creating a care plan.

In a series

Good practice guide

Functional and social assessment in CGA

04 February 2016

Functional assessment examines factors like mobility and daily living activities, and social assessment looks at social circumstances. Asking what the older person does and what environment they live in adds context to any Comprehensive Geriatric Assessment.

In a series

Good practice guide

CGA issues: bone health

01 February 2016

Older people with frailty, those with reduced mobility and those with multiple co-morbidities are all susceptible to problems with bone health.

In a series

Good practice guide

NICE: Intermediate care including reablement

10 August 2018

NICE standard covers referral and assessment for intermediate care. It covers bed-based intermediate care, crisis response, home-based intermediate care and reablement. It describes high-quality care in priority areas for improvement.

Good practice guide

Frailty: what’s it all about?

23 May 2018

Good practice guide

Simulated practice to improve care

20 April 2018

This Practice Question has been published with the kind permission of the Royal College of Nursing.

Could simulated practice with registered nurses improve the delivery of healthcare for older people in hospital?

Members only

In a series

E-learning

Peri-operative Care for Older Patients Undergoing Surgery

23 January 2015

The rate of older people undergoing surgical procedures is increasing faster than the rate of population ageing . Despite this progress, older surgical patients remain at increased risk.

Good practice guide

Occupational Therapy: putting prevention at the heart of care

14 October 2017

In its report Living Not Existing: Putting Prevention at the Heart of Care for Older People, the Royal College of Occupational Therapists seeks to show how doing the right thing for individuals can actually reduce their need for expensive care long-term.

Report

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Managing Frailty and Delayed Transfers of Care in the Acute Setting: A call to get involved!

30 July 2018

This project provides a unique data set on the pathway of frail older people through secondary care, from assessment in A&E, assessment units, inpatient wards and supported discharge. The project gives insight into why this cohort of patients appear to be more prone to delayed transfers of care. The BGS has also worked with the NHS Benchmarking Network to develop a short service user audit which will be included in the project.

Blog

10 days in a hospital bed leads to 10 years’ worth of lost muscle mass in people over age 80

25 July 2018

I have lost count of the number of times I have quoted this fact, I use it when teaching on frailty, and I have used it when assessing people in the emergency department to explain the risks of hospital induced deconditioning. I regularly hear other Geriatricians use this fact. It is emblazoned across much of the #EndPJParalysismaterial, and is quoted (unreferenced) on the NHS improvement website.

Blog

Yoga-based exercise can improve well-being for older people

18 July 2018

Yoga-based exercise offers a safe and accessible way to improve health-related quality of life and mental well-being for people over 60. Evidence for a moderate benefit of yoga in later life now extends beyond improved balance and flexibility.

Blog

Do attitudes toward older patients even matter?

15 November 2016

Does it matter if doctors like older patients? Is there any point in working out if they have positive or negative attitudes towards older patients? Surely it’s irrelevant because doctors are professionals that separate their personal and professional feelings. Maybe they can, but that’s not why these questions are important.

Blog