Looking After Your Musculoskeletal Health

This week in Public Health England’s Health Matters Blog they have chosen to focus on older people’s Musculoskeletal (MSK) Health. A good time of year to focus on this as today the outside temperature across most of Scotland today fell to -2 degrees Celsius. So its a high risk of falls day (and a put on your big coat day as we’d say here)

The Public Health Blog focusses on the burden of the three groups of MSK conditions:

  • Inflammatory conditions such as rheumatoid arthritis
  • Conditions of musculoskeletal pain such as osteoarthritis and back pain
  • Osteoporosis and fragility fractures such as fracture after fall

As well as age, the prevalence of MSK conditions is being fuelled by rising levels of physical inactivity and obesity, and poor health habits such as smoking. MSK conditions are a substantial problem for individuals and the NHS. The blog looks at how local authorities, commissioners, healthcare professionals, and the private and voluntary sectors can all contribute towards promoting productive healthy ageing and preventing the onset of MSK conditions. It includes a set of infographics and slides to support local commissioning and service delivery, as well as best practice case studies, so why not have a look and make use of them.  See

https://publichealthmatters.blog.gov.uk/2017/12/06/health-matters-productive-healthy-ageing-and-musculoskeletal-health/

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Austerity, and 5 Pieces of Advice You Should Listen To

 

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Can’t think of anything sadder than seeing older people in extreme poverty

 

Its Black Friday today so most of you will not be looking at this, you’ll be shopping! Its Black Friday though for other reasons after the budget being announced in the UK and no obvious end to austerity or scrapping the cap on pay rises that virtually all UK healthcare workers are experiencing. While that might seem like more moaning the implications for older people in hospital and requiring social care are discussed very effectively in this peice published by the British Geriatric Society on their Blog. So rather than me picking out something have a look at what Dr Eileen Burns, President of the British Geriatrics Society has said.

https://britishgeriatricssociety.wordpress.com/2017/11/23/the-budget-was-a-missed-opportunity-to-help-frail-older-patients-stranded-in-hospital/#more-4923

So as a counter to all that depressive talk about underfunding and its short and long term impact maybe we need to calm down a little and listen to our seniors.

This is another peice from the TED Blog. Yes TED again! You know I am big fan of the talks TED: Ideas worth spreading    So they also have a blog  and this was their Thanksgiving post; “5 Pieces of Essential Life Advice from Seniors” I bow to their wisdom. This is what they said:

  1. Think of hard times like bad weather — they too will pass.
  2. Draw inspiration from all the people you meet.
  3. Love your work — for the salary and for the people.
  4. Find mentors who can guide you and challenge you.
  5. Make the most of less.

To find out more and watch a TED talk about what we get when we listen to people’s stories CLICK HERE

 

Dying Comfortably

Last month saw the publication of one of those papers that helps confirm something that you always believed you knew. So what did it confirm?

Very old people are more likely to die comfortably if they die in care homes or at home when compared to hospitals. The study carried out by a nursing team at the University of Cambridge found that the oldest old do not always receive effective symptomatic treatment at the end of life. While that is true in most settings up to four times more are likely to die comfortably in a community setting when compared to hospital. So what’s the message? Training for end of life care needs to be improved for all staff, at all levels but perhaps more telling is the need for governments (not just in the UK) to review the funding of long-term care so that more people have the opportunity to die in their home/ care homes than currently so that late admission to hospital is less likely. Not a new message but maybe its time to sit up and take notice. To download the paper go HERE

Sticking with the same topic an End of Life Care resource called “Let’s Talk About Death and Dying” has been produced by Age UK and the Malnutrition Task Force. The materials were produced in a response to a survey showing yet again that conversations about death remain a taboo topic. The new video is below:

 

What’s Been Happening at NICE?

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This is probably the longest gap in posts since I started this weekly Blog so for regular followers my apologies for missing last week completely. I was unwell last week and didn’t feel well enough to post, which was followed by a very busy week when I just ended up each night too tired to write.

Hopefully, normal service is now resumed and I might even try and do an extra post this week.  So the question now that I am back, has to be why am I drawing your attention to the National Institute of Healthcare Excellence (NICE).

Well as many of my students know I have not been a big fan of what they put on their website until quite recently. I never thought that it was enough to just release Guidance and not really do much to show or explain how it should be used. However, that’s all changing. I am a big fan of their Pathways, very handy if you are trying to work out what ideal care in the UK should look like for particular illnesses and conditions. I am also probably an even bigger fan of their Clinical Knowlege Summaries which are really useful when you are considering what to do in practice. They are almost like checklists for what you should be doing in particular circumstances and incorporate all the appropriate NICE guidance.

Now they are doing it again. They have started producing a series of Quick Guides, developed jointly with the Social Care Institute for Excellence (SCIE) which are based on NICE guidelines and health and social care quality standards (Unfortunately the English ones and not the Scottish ones). There aren’t many yet but it’s really worth keeping an eye on these as the collection grows particularly if you are involved in integrated care, social care or providing care home care.

The most recent one is for intermediate care services, which help people to recover from illness or an accident, to regain independence and to remain in their own homes. This new guide gives people who use the services and their families and carers an overview of:

  • The types of service available
  • The four stages of intermediate care
  • The professionals involved in providing care

A new place to look for well-written evidence-based and useful materials.

 

 

Oncogeriatrics? My “What’s wrong with the BBC’s Health Tracker” Rant

This week I am going to refer to another Blog piece from the British Geriatrics Society because it’s written by someone working locally in the West of Scotland. Dr. Kirsty Colquhoun has been a consultant geriatrician, working in Glasgow, since August 2015 and her specialty is Oncogeriatrics. Not a term I am either familiar with or like but let’s just go with it. In her blog she discusses the BGS Oncogeriatrics Conference on 7 December 2017 at the Wellcome Collection in London. Worth a look even if it’s just to get your hands on the Cancer Services Coming of Age Report from 2012. I may not like the name chosen for what she does but I would support her in her efforts to see Comprehensive Geriatric Assessment used in cancer care as well as other areas where it’s also extremely useful. See this Cochrane Review   about its use.

This week also saw the release by the BBC of their NHS Tracker. The tracker uses the latest published data on performance against three key NHS waiting-time measures:

  • A&E treatment
  • cancer care
  • planned operations and care, such as knee and hip replacements

and pulls this data from currently published NHS and Government office data to allow comparisons across the UK, but be warned there are differences between how the targets are measured in each part of the UK. So is this a good thing or a bad thing? My own feelings are neither of these. It’s missing the point completely. Of course, the NHS is missing its targets. Its grossly underfunded, short of staff and very short of staff in key positions, like radiology, gerontology and more…. Do we really need another measure of how bad things may be getting, or should we tackle this! (chronic underfunding when compared with other westernised economies)

 

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From https://epianalysis.wordpress.com/2012/07/18/usversuseurope/

Scotland’s Obesity Issue and What About Mental Health?

This week saw the publication of the Scottish Health Survey for 2016. Possibly the most significant piece of news from this for older people was the following information reported on BBC Scotland’s Health Page Scotland’s health: What we learned

From the report, they have stated that amongst adults men were significantly more likely than women to be overweight including obese (68% compared with 61%). Worryingly it was adults aged 65-74 who were most likely to be obese (36% of all adults this age). The average BMI (Body Mass Index) for both Scottish men and women was 27.7, up from 27.0 in 2003.A BMI of 25 or less is said to be normal and 25 to 30 is overweight.

A BMI of 25 or less is said to be normal and 25 to 30 is overweight.

Obesity was lowest in the 16 to 24 age group (14%) but it doubled to 28% in the 25-35 range. The largest jump between age groups. It would appear that while the message to reduce obesity in Scottish children is getting through to the public the same cannot be said of the message about the need for our older people to avoid obesity and stay active to reduce the likelihood of cardiovascular disease and diabetes. The Scottish Government are planning an ambitious new strategy to improve Scotland’s diet and help address obesity. Let’s hope they include older people in their plans.

For information about staying healthy in old age, this page on the Age Scotland site is useful

Perhaps a missing element from this survey is more detail on the mental health of older people. More will be reported about this but it’s perhaps worth remebering that up to 40% of people over the age of 65 experience mental health problems and about one-fifth of all suicides happen in older people. Last month Alistair Burns, the National Clinical Director for Older People’s Mental Health and Dementia took to social media to announce the launch of “A Practice Primer on Mental Health in Older People” a document which highlights for  primary care health workers in particular GP’s, symptoms often attributed to ‘old age’ but where a mental health diagnosis and follow-up may be more appropriate.

You can read what he said here and find the link to the document he is discussing (if you didn’t click the link above already) In the document he talks about this film that looks at Improving Access to Psychological Therapies. I am with him on this!

 

International Day of the Older Person 2017

The International Day of Older Persons is observed on October 1 each year. So today is the day and I thought I should mark it.

This year’s theme is about enabling and expanding the contributions of older people in their families, communities and societies at large. It focuses on the pathways that support full and effective participation in old age, in accordance with old persons’ basic rights, needs and preferences.

The UN has stated that this year’s theme underscores the link between tapping the talents and contributions of older persons and achieving the implementation of the 2030 Agenda for Sustainable Development and the Madrid International Plan of Action on Ageing, which is currently undergoing its third review and appraisal process.

The message for this year from the United Nations is here 

The World Health Organisation also has a message on their Ageing and Life Course pages. Given that their focus this year is on Universal health coverage it’s a good day to watch this!