Julie wilkinson

Read our joint @cpoc.bsky.social @gerisoc.bsky.social
Guideline for Perioperative Care for People Living with Frailty Undergoing Elective and Emergency Surgery.

➡️Whole pathway approach
➡️Highlights tools and resources
➡️Multidisciplinary

Info here: shorturl.at/3dXoT

Anticholinergic meds are associated with poor cognition in schizophrenia, further confirmed by new 21-year study:
pubmed.ncbi.nlm.nih.gov/38237360

Learn more on reducing the anticholinergic load in the Carlat psychopharm textbook:
amzn.to/48yb7Y5

♥️ To provide compassionate care for people with delirium we need to:

➡️ detect & document it formally

➡️ communicate the Dx to pt & carers

➡️ alongside treating triggers, etc., consider the 𝒑𝒆𝒓𝒔𝒐𝒏 - how are they feeling? Do they need explanation & reassurance?

🔗 academic.oup.com/ageing/artic...

Fantastic to see @jkdhesi.bsky.social, President of @gerisoc.bsky.social speaking on @bbcbreakfast.bsky.social about the difference we can make through acute frailty units to deliver better care to older people who present with emergencies.

40% of ED attendances are over 65yrs. Average wait for admission in>75yrs =12 hours. 10% attendances from care homes. Waiting is especially bad for older -risk of delirium, deconditioning, acute kidney injury/LOS. But much could be done to avoid these probs @gerisoc.bsky.social @rcem.bsky.social

Lots of research out there on the subject. This is an article I found useful

Outcomes associated with postoperative cognitive dysfunction: a systematic review and meta-analysis AbstractBackground. Postoperative cognitive dysfunction (POCD) manifests as a subtle decline in cognition, potentially leading to unfavourable postoperativ

academic.oup.com/ageing/artic...

Important to make sure older surgical patients are aware of the risk of cognitive decline prior to surgery. Shared decision making is vital

The best part of the day is advent calendar breakfast cheese in a silent office

Cartoon where ECG squiggles rise off page and become an older woman.

Flowchart for management of AF depending on fitness or frailty.

WHAT YOU NEED TO KNOW • Atrial fibrillation predominantly affects older adults. Given the heterogeneous nature of ageing, disease focused randomised controlled trials and guidelines may not be applicable across the broad spectrum of this population • To inform decision making, clinicians should assess an individual's level of function and frailty, and discuss their treatment goals, using evidence based shared decision making tools where available and appropriate • Evidence needs strengthening to inform individualised care for the growing population of older adults with atrial fibrillation

Much common sense in this feature in last week’s @bmj.com on older adults with atrial fibrillation (AF).

It’s four pages long, but the punchline is that you need to look at the patient as well as the ECG and work out WITH THEM what the goals and priorities are.

#MedSky

www.bmj.com/content/386/...

The anticholinergic burden in patients with chronic kidney disease: Patterns, risk factors, and the link with cognitive impairment Background People with chronic kidney disease (CKD) have an elevated risk of cognitive impairment (CI). Medications with anticholinergic activity are recognized for their adverse reactions on centra...

#anticholinergics
Study emphasises the importance of careful prescribing of anticholinergic drugs for patients with CKD.
Cognitive impairment, risks.
#pharmSky #MedSky
doi.org/10.1111/jgs....

Treating iron deficiency in patients with heart failure: what, why, when, how, where and who For patients with heart failure and reduced or mildly reduced left ventricular ejection fraction, iron deficiency is common and associated with more severe symptoms, worse quality of life and an incre...

'For patients with heart failure and reduced or mildly reduced left ventricular ejection fraction, iron deficiency is common and associated with more severe symptoms, worse quality of life and an increased risk of hospitalisations and death' #anemia #iron #cardiosky
heart.bmj.com/content/110/...

Love this

At one of my first meetings as a council member of the Royal College of Surgeons of England, we approved a report called Access All Ages. It encouraged less ageist thinking and bias among healthcare staff that might lead to them denying older people surgery. But sometimes an operation isn't the best option. Among patients who have surgery, 14% express regret and 15% experience complications, which are at least four times as likely if they're frail or physically inactive. The Centre for Perioperative Care has published information on the importance of exercise before surgery, but that alone may not be enough. We need shared decision making, including asking patients what matters to them. The public should be primed to ask about BRAN-the benefits, risks, and alternatives to surgery and the likely result from doing nothing. A slew of data supports this approach, especially from the Perioperative Care of Older People Undergoing Surgery (POPS) initiative. After discussion with a geriatric medicine team completing a comprehensive assessment and using shared decision making with a POPS approach, 14.8% of patients decided against surgery. Most of these then had their health improved through other means: adjusted medication, lifestyle advice, or other interventions.

This is a very helpful piece in the @bmj.com from @scarlettmcnally.bsky.social on improving shared decision making in medicine (here specifically, surgery).

When we talk about waiting list numbers, I’d be keen to know whether everyone on them has had a thorough review as described.

#MedSky

And such an important subject

#ChooseGeriatrics
Profile: @adamgordon1978.bsky.social
Immediate Past President BGS

Adam says:
“Geriatric medicine means being on a mission to improve care some of our most vulnerable citizens. That feels important to me.”

If you are an advocate, geris is for you!
@gerisoc.bsky.social
👉🏻Repost

Appropriate management of heart failure in older people with frailty Guideline directed medical therapy for heart failure for older people with frailty may do more harm than good, say Henry Woodford and colleagues The management of heart failure is evolving. Recent c...

Should the management of people with frailty and heart failure deviate from the guidelines?
@lucypgeridoc.bsky.social

www.bmj.com/content/387/...

YouTube video by The Body Coach TV by Joe Wicks 10 Minute Chair-Based Workout for Pre-Op Patients | Joe Wicks Workouts

Centre for Perioperative Care and Guy’s and St Thomas’ NHS have teamed up with @thebodycoach.bsky.social to create two 10-min online videos to help increase activity levels in people who are waiting for an operation, and are particularly suitable for older people 💪 www.youtube.com/watch?v=C7XQ...

YouTube video by The Body Coach TV by Joe Wicks The Benefits of Exercise Before Surgery | Interview with Professor Jugdeep at Guy's and St Thomas'

Great fun to be working with @thebodycoach.bsky.social to help people get ready physically & mentally for surgery. Of course applies to us all - lets ensure healthy ageing for the future! Thank you to @gstt-nhs.bsky.social @cpoc.bsky.social @gerisoc.bsky.social
youtu.be/xBLtxMsVWjA?si…

www.bgs.org.uk/policy-and-m...

'I much prefer the British spelling of “diarrhea” which is “diarrhoea” because it looks like you’ve lost control of your vowels.' -- Sal Robins

NHS England » How to use a decision support tool Train teams in shared decision making To get the most out of these tools it is important that clinicians understand the benefit of using them and have the skills to incorporate them into a shared deci...

www.england.nhs.uk/personalised....

Would love to be added

Up early for the Las Vegas Grand Prix with coffee so strong I could stand a spoon up in it

A list of bands in order of efficacy:

3. Placebo
2. The Cure
1. Prevention

Increasing fitness reduces post op complications
#periSIG24
AnSky MedSky

The view from work @luhft.bsky.social

Picard management tip: When you're threatened with catastrophe, it's rational to try a risky maneuver.

Poster of the Choose Geriatrics campaign with the website link about this

As we reach the end of an amazing 3 days of #BGSConf here's the link for the #ChooseGeriatrics campaign to attract doctors, nurses and AHPs to come and work with older adults.
www.bgs.org.uk/choose

Great article on perioperative management of anaemia
authors.elsevier.com/a/1k3Lw4qdNo...