Polypharmacy and the complexity of deprescribing medications – Dr Kinda Ibrahim

Dr KInda Ibrahim, is a Senior Research Fellow based in the Faculty of Medicine at University Hospital Southampton

The concurrent use of 5 or more medications by one individual – is becoming increasingly a challenging phenomenon that demands attention at clinical policy and practice level. In the past decade, the average number of items prescribed for each person per year in England has increased by 53.8% from 11.9 to 18.3. It is 35-50% of community older people aged 65 years and above take 5 or more medications. The King’s fund ¹ published in November 2018 a report “Polypharmacy and medicines optimisation: Making it safe and sound” where they distinguished between the terms ‘appropriate’ and ‘problematic’ polypharmacy.

Appropriate polypharmacy: means prescribing for an individual for complex conditions or for multiple conditions in circumstances where medicines use has been optimised and the medicines are prescribed according to best evidence.

Problematic polypharmacy where multiple medications are prescribed inappropriately, or where the intended benefit of the medication is not realised.

The rights of people with dementia -Jackie Bridges – Professor of Older People’s Care, University of Southampton

Not so long ago CLAHRC East of England Research Capacity in Dementia Care Programme (RCDCP) joined forces with the University of Southampton Alzheimer’s Society Doctoral Training Centre to provide a European Summer School for 17 dementia care doctoral students. Hosted by the University of Linköping in Sweden, the programme enabled participants to share ideas, build international partnerships, and learn from leaders in dementia care research.

Professor Jackie Bridges explains some of the lessons we can learn about caring for people with dementia.

She was particularly struck by the approach of a day centre she visited whilst on the trip.

Frailty – a team approach to learning. Dr Melinda Taylor and Dr Alex Recio-Saucedo

Dr Melinda Taylor, Senior Research Fellow in Organisational Behaviour, NIHR CLAHRC Wessex Data Science Hub

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The first blog in this series described how health professionals in our study found it difficult to define ‘frailty’ but agreed that it was an extremely broad concept with no defined boundaries. This has an impact on training in frailty care. This second blog outlines our participants’ views on frailty care training.

Our study evaluated particular aspects of four initiatives intended to enhance the care provided to people regarded as frail. The diverse nature of the initiatives further demonstrates the complex nature of frailty.

Let’s learn about Frailty: a blog series on training for healthcare staff in this complex field. By Alex Recio-Saucedo and Melinda Taylor

This is the first of a series of blogs drawing on a study of training for those working in frailty care, with additional reflections from other work.

What is frailty?

Before looking at training in frailty care, it would be helpful to understand something about what frailty is. Descriptions of frailty will almost always refer to the complexity of the condition. But what makes frailty different to other conditions that could be described as complex? We might think perhaps of multiple sclerosis, in which the patient may experience a range of clinical conditions and in which physical, psychological and social factors need to be taken into account. The same can be said for patients diagnosed as frail. Well, in a recent study, our participants considered that the complexity of frailty; how two patients could have such a wide disparity of signs, symptoms and needs; its evolving nature; its acute susceptibility to interventions or to the lack of them, and the high number of professions, sectors and organisations necessary to carrying out effective frailty care, were sufficient reasons for it to stand apart.

What are we missing here? (Are at risk older people spotted early enough in hospital?) – Dr Kinda Ibrahim, Research Fellow at Academic Geriatric Medicine

Nearly two thirds (65%) of people admitted to hospital in the UK are aged over 65 years old. Many of them are frail and at high risk of poor healthcare outcomes – like staying longer in hospital, reduced physical abilities, becoming dependant, going to a care home, and even death.

National recommendations suggest that these high-risk older individuals should be routinely identified when they are admitted to hospital to allow healthcare teams to provide appropriate individual care that meets patient’s needs (1).  It is unclear whether and how those people are identified in hospital. Therefore our study looked at the current practice in one hospital with regard to identification of patients at high-risk of poor healthcare outcomes. To do that, we reviewed a random sample of patient’s clinical notes and interviewed staff members who worked at five acute medicine for older people wards (2).

Dementia care at meal times in acute hospitals – Naomi Gallant

Almost a year on from my last post here and I’ve done a lot of work on my developing my research proposal – reading, learning, literature reviewing – but sadly not a lot has changed for people with dementia in acute hospitals. My desire to improve the quality of care, especially at meal times has certainly grown.

Getting a grip on high risk older inpatients with low grip strength -Dr Kinda Ibrahim and Dr Helen Roberts, Associate Professor in Geriatric Medicine

Our muscles play an important role in our health and grip strength is a good way of measuring how well our muscles are doing. Our grip strength builds through young adulthood to reach its peak in our 30s after which it gradually tails away. It is a reliable and valid way of evaluating someone’s hand strength, which in turns provides an objective measure of the skeletal muscle strength and function in their whole body.

Love thy neighbour – why friends may be the answer to staying well.

Professor Anne Rogers is Professor of Health Systems Implementation in the Faculty of Health Sciences, University of Southampton and Research Director of the NIHR CLAHRC Wessex

Professor Anne Rogers explains how weaker social ties play a role in helping people manage a long term illness.

With ever more attention on the NHS and how many nurses and doctors are needed to give people the best care, one part of the health equation is going unnoticed – What attention is being paid to the role of the patient and their extended network of relationships? In early 70s West Coast America a piece of research by Anselm Strauss and colleagues examined a set of questions on ‘self-care’.

Where do people want to draw the line? Making shared decisions about treatment. Professor Alison Richardson

Professor Alison Richardson is Clinical Professor of Cancer Nursing and End of Life Care at the University of Southampton and University Hospital Southampton NHS Foundation Trust

Many patients whose condition becomes worse during their stay in hospital face uncertainty about the likelihood of recovery. For patients, families and healthcare professionals deciding on the best thing to do can be hard.

Appetising research – How we’re Introducing Volunteer Mealtime Assistants for older inpatients across University Hospital Southampton

Dr Helen Roberts is Associate Professor in Geriatric Medicine and Theme 2 lead for Improving Routine Care for Ageing and Dementia for NIHR CLAHRC Wessex

Poor nutrition in hospital inpatients is a problem that is becoming increasingly recognised both in the UK and worldwide, and requires a multifaceted approach, including protected meal times, red trays and protein and energy supplementation as required. One factor that particularly affects older inpatients is the amount of assistance they receive at mealtimes. Time-pressured nursing staff may not have the time they need to help patients with their meals.