Abstract
Website of the month
The Good Grief Trust has resources for people who have been bereaved – both local and national. The resources are divided into the type of loss (e.g. partner, sibling, friend) and a specific section with blogs and videos from children and young people.
Considering frailty
In writing this month’s News and Views, for the first time I gained a clearer definition of what frailty really is. I found the British Geriatrics Society’s description ‘a state associated with low energy, slow walking speed and poor strength’ and that ‘it is a syndrome with characteristic features’ enlightening, having previously perceived it as a non-specific umbrella term for elderly patients with declining health. A great week for continuing professional development! I found it quite uplifting to learn more about the topic. Rather than being a ‘doom and gloom’ picture, there are preventative steps and ways of improving the health of the elderly population who are indeed ‘frail’.
Visual problems in the elderly
An excellent guide for GPs entitled ‘Sight loss in older people’ has been produced by the Royal National Institute for the Blind in partnership with the RCGP. This document covers information about the identification and assessment of visual problems for GPs. However, it also provides a wealth of information on how practices can assist patients with visual loss and enhance their care experience.
Sinclair A, Cunningham B and Hill D (2014) Sight Loss in Older People. The Essential Guide for General Practice. London: Royal National Institute of Blind People. Available at: www.vision2020uk.org.uk/ukvisionstrategy/GPguide
Help with hearing aids
Another of the five senses commonly affected as we age is hearing. An excellent resource for practitioners and patients is the hearing charity ‘Action on Hearing’. One concern of mine is that, often, substantial sums of money are spent on hearing aids (the average reportedly being around £3000 for a pair of hearing aids), which ultimately are not worn by the patient. This charity has an excellent downloadable handout on their website that covers detail on acquiring hearing aids, including the cost and important points for patients debating whether to get hearing aids privately.
Fitness to prevent frailty
Many readers will be familiar with online fitness videos, for example Joe Wicks high intensity training ‘HIT’ workouts or ‘Yoga with Adrienne’, both free resources on YouTube with millions of views. There are more and more free fitness resources for older or perhaps more frail patients. The ‘NHS Fitness Studio’, which I have brought up before in News and Views, has videos such as ‘Chair Pilates’, ‘Pilates with Osteoporosis’ and ‘Pilates with Knee Pain’. Some branches of Age Concern also run exercise classes. Checking what is available locally again may be useful in putting together a resource for patients. For those not online, often local libraries have DVD sections and will take requests – perhaps there are fitness DVDs for elderly patients to take out on loan.
Learning not lonely
I work as a GP in North East Fife, and several of my patients have mentioned ‘U3A’. U3A is the ‘University of the Third Age’ and they describe themselves as ‘a UK movement of retired and semi-retired people who come together to continue their educational, social and creative interests in a friendly and informal environment’. This involves a wider range of activities, including lectures, group discussions and meetings, trips covering a variety of different interest areas. On the website are links to local U3A groups across the UK. It may be worth exploring this as a resource to recommend to patients seeking more social interaction or pursuing old, current or new interests.
#learningnotlonely
Best foot forward
I had to use the title of the Age Concern document for this snippet! I am sure, like many readers, I have seen many older patients wearing somewhat dubious footwear. This includes slippers and shoes with parts cut out of them or digging into the flesh of patients with pedal oedema. The document from the aforementioned charity covers exercises to keep feet and ankles strong, and provides a guide to safe footwear. There is actually a wealth of literature around footwear and foot problems in the elderly. The key message seems to be, get feet measured and wear well-fitted shoes. However, as the authors comment, there may be difficulties for some elderly and frail patients getting out to a shoe shop.
www.ageuk.org.uk/Documents/EN-GB/Falls/ID201320%20FAW%20best%20foot%20forward.pdf?dtrk=true
Burns S, Leese G and McMurdo M (2002) Older people and ill fitting shoes. Postgraduate Medical Journal 78: 344–346. DOI: 10.1136/pmj.78.920.344.
Nutrition and diet for older adults
The British Nutrition Foundation have some excellent information on their website on nutrition through life, including in older adults. A supplement of 10 micrograms of vitamin D is recommended for all older adults. Interestingly, low levels of vitamins B6, B12 and folate are associated with a higher incidence of stroke. So, it is important to consider these deficiencies in those with a poor diet, in institutions or with clinical indications, such as macrocytic anaemia.
www.nutrition.org.uk/nutritionscience/life/older-adults.html
Assessing anaemia
Anaemia has been identified as a risk factor for frailty in the elderly. I have to say, at times I find reduced haemoglobin levels in otherwise well elderly patients a challenge. How far should we investigate an underlying cause? Doing a little research has made me feel better – a retrospective study published in 2018 in the British Journal of General Practice concluded that ‘further work is needed to understand the approach to anaemia in older adults in primary care’. This study suggests that anaemia in patients over 65 may be under-investigated and demonstrated that less than half the patients had haematinics performed. Of patients identified as anaemic according to World Health Organization guidelines, 29.1% did not have a repeat full blood count within 24 months. This is an area that could be explored within practices, for example exploring development of a flow chart with an agreed approach to investigation of elderly patients with anaemia. Ultimately, if contributing to tiredness and frailty, investigation and treatment seems appropriate.
McCartney D, Shine B, Hay D, et al. (2018) The evaluation of anaemia in an older primary care population: Retrospective population-based study. BJGP Open 1(4): bjgpopen17X101157. DOI: 10.3399/bjgpopen17X101157.
Companionship
It is important to consider social isolation in ageing, isolated patients. Frailty in the elderly often affects their ability to get out and see people, attend clubs and social events, or even to interact with the community, for example at the shops or at the bus stop. Age Concern offers opportunities for two forms of befriending: Telephone befriending or local face-to-face befriending.
Think kidneys
NHS England has supported Think Kidney to develop a range of supported QI activity and educational resources across all healthcare boundaries. The e-learning, examples of existing projects and forum advice might be very useful for general learning about QI, or if you want to do a renal-based QI project.
ORCID iD
Dr Clare Etherington https://orcid.org/0000-0002-1446-627X