BGS Scotland

Which screening tool(s) should clinicians use for the detection of delirium in older, hospitalised patients?

Kirsty Hendry is a research assistant based at Glasgow Royal Infirmary having recently completed her PhD at the University of Glasgow. In this blog she discusses her recent Age and Ageing paper looking at screening of delirium in older, acute care in-patients. Kirsty can be contacted at Kirsty.Hendry0@gmail.com

A&ADelirium, suggested to be the most common psychiatric disorder suffered by older hospitalised individuals, has a low clinical awareness. This is despite existing guidelines such as those produced by the National Institute for Health and Care Excellence (NICE) and Healthcare Improvement Scotland (HIS) being in general agreement that delirium screening is important in older hospitalised patients. 

There are a number of negative outcomes associated with delirium including increased risk of falls, dehydration, long-term cognitive impairment, institutionalisation and mortality. Identifying patients with delirium is essential to facilitate good patient care and to allow for the appropriate support of relatives and carers. There are a wide range of delirium screening tools available with limited validation of these tools within large, representative cohorts. MOTYB How do clinicians go about screening for delirium effectively?

If it’s everyone’s business, lets make a plan

From the BGS blog: Pamela Levack is Medical Director of the charity PATCH – Palliation And The Caring Hospital contactus@patchscotland.compatch

David Oliver’s recent blog in the BMJ End of Life Care in hospital is everyone’s business, reports on the findings of the recent Royal College of Physicians Audit into End of Life Care. The two main findings, a need to increase the number of specialist palliative care doctors and specialist palliative care nurses in hospital and to ensure that newly qualified doctors have more knowledge and confidence dealing with end of life situations, match the aims of our recently established charity PATCH Palliation And The Caring Hospital.

PATCH is presently a Scottish charity but the issues are the same throughout the UK. It was inspired by the Acute Palliative Care Unit in Ninewells Hospital, Dundee. This was established in 2009 with charitable money but is now NHS funded. Based on ten-year hospital palliative care team data, we believe there is a population of patients in a busy acute hospital who benefit from an intensive palliative care approach from a number of disciplines including social work, occupational therapy, physiotherapy, pharmacy, spiritual care, and pain service in a dedicated on site unit.

A life-course perspective necessary to improve the health of older adults

Dorota Chapko is a PhD candidate in Public Health at the University of Aberdeen in Scotland, and a graduate from the Massachusetts Institute of Technology (MIT) with a double-major in Brain & Cognitive Sciences and in Anthropology. In this blog she discusses her recent Age & Ageing paper on the triad of impairment; she tweets at@dorotachapko

Although frailty is a central concept in clinical assessment of older people, there is no consensus definition. The concept is certainly multifactorial but physical components dominate. However, it is known that age-associated physical decline is likely to be accompanied by cognitive and emotional deficits. The ‘triad of impairment’ (triad) recognises the co-occurrence of cognitive, emotional and physical deficits in late-life and might be a useful alternative to ‘frailty’.

Challenging the depiction of delirium in the media

The media’s portrayal of vulnerable elder people as ‘perpetrators of assaults’ shows us just how far we still have to go.

Dr James Woods is a registrar in Geriatric and General (Internal) Medicine in South East Scotland. He tweets at @jmwoods87

Earlier this week BBC Radio 5 Live ran a piece with corresponding BBC website article reporting on figures obtained from an NHS Protect report on physical assaults against NHS staff in England. The headline and corresponding analysis focused on patients over 75 years old as the most frequent ‘perpetrators of assaults’ against NHS staff. If you care about the healthcare needs of older people and want to see them treated with dignity and respect (which if you are reading this blog you probably do) then this makes for distressing reading.

Emotive language does these vulnerable people a huge disservice. Not only are they referred to as ‘perpetrators of abuse’ (a hugely pejorative title) in the headline but their actions were repeatedly described as ‘lashing out.’