Tag Archives: elderly

Dr Lara Mitchell gives advice on how to have difficult conversations These are the words of Dr Lara Mitchell (pictured right), a Consultant in Medicine for the Elderly (Queen Elizabeth University Hospital, Glasgow; NHS Greater Glasgow & Clyde). She is also Chair of the British Geriatrics Society Cardiovascular Special Interest Group and a BJC editorial board member. To give healthcare professionals a visual approach to support with difficult conversations around dying with compassion and honesty, Dr Mitchell has produced resource materials with Open Change, an educational design company. A structured way that healthcare professionals can

Currently, UK, US and World Health Organization (WHO) aerobic guidelines all advocate at least 150 minutes weekly of moderate-to-vigorous physical activity (MVPA) in at least 10-minute bouts for adults and older adults,1,5,6 though the bout requirement is currently under debate,6 and even small amounts of physical activity provide protective health benefits. Walking is by far the most common physical activity, a brisk pace (approximately 3 mph, 5 km/hr) counts as MVPA, and walking is considered a ‘near-perfect’ exercise, with ability to gradually increase frequency and intensity with low risk of harm, while encouraging environmental sust

The study The research is presented as a retrospective case-control study in the modern era of coronary intervention, and gives some insight into current practice. Data from 100 randomly selected patients aged over 80 years and a control group aged below 70 years were taken from a district general hospital (DGH) DCA database. This method of patient selection is perhaps the major weakness of the study. There will inevitably have been a high degree of case selection – particularly of older patients – with those put forward deemed appropriate for DCA (and by implication also considered ‘reasonable’ candidates for revascularisation). The

First, there is a much higher incidence of comorbidities in the elderly, which increases the potential for complications and may limit the scope for symptomatic improvement. For example, there may be little point in treating exertional angina when the patient is more limited by an arthritic knee. Second, care needs to be exercised when considering the benefits of prognostic interventions in a group that statistically have a relatively short remaining lifespan. These concerns emphasise the importance of studies specifically examining the response of the elderly to cardiovascular treatments – historically an area that has been overlooked. We

NICE updates A new ‘Evidence Update’ has been produced by the National Institute for Health and Clinical Excellence (NICE), which summarises selected new evidence relevant to the NICE guideline on the management of chronic heart failure (CHF) in adults in primary and secondary care (clinical guideline 108).NICE says “Whilst Evidence Updates do not replace current accredited guidance, they do highlight new evidence that might generate a future changes in practice.”  It says it will welcome feedback from societies and individuals in developing this service. The update is available from www.evidence.nhs.uk/evidence-update-2. New guides

Introduction The average age and risk profile of patients undergoing cardiac surgery are steadily increasing and present new sets of challenges to surgical care. Whereas the clinical implications of this demographic change continue to be the focus of ongoing investigation,1,2 the impact on care and clinical resource utilisation has not been clearly defined, even though studies have shown higher costs for octogenarians.3,4 Cost of care is a major issue in healthcare delivery, and cost-effectiveness in universal healthcare schemes like the National Health Service (NHS) is critical to sustainability.5,6 The core founding principles of the NHS �

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