Health Care for Older People

Consultants

Dr Lynne Armstrong

Dr Ken Fullerton

Dr Peter Passmore

Dr Maeve Rea

Professor Bob Stout

Dr Hugh Taggart

Dr Ivan Wiggam

Service summary:

Profiling Excellence – Elderly Care Medicine

As we age, we tend to have higher rates of sickness, different patterns of disease presentation, slower response to treatment and more requirements for rehabilitation than younger people. It is because of these differences that the medical speciality of Elderly Care Medicine is important. Healthcare professionals in Elderly Care Medicine aim to work with people who are ill or disabled to restore them to a level of maximum ability and wherever possible return them to independent living at home.

Assessment and treatment is provided by a specialist multidisciplinary team of nurses, physiotherapists, occupational therapists, speech and language therapists, podiatrists, pharmacists, dieticians, social workers and doctors.

Elderly Care Medicine in the Belfast City Hospital Trust provides a range of in-patient, outpatient and Day Hospital Services. Inpatient care is provided in 60 acute assessment beds on Ward Floor 7, and in 86 rehabilitation beds in the Elderly Care Unit (ECU). Outpatient services include general elderly care clinics and a range of sub-speciality clinics including Osteoporosis, Memory, Neurovascular or Stroke and Falls. The Day Hospital provides ongoing complex rehabilitation to selected patients discharged from hospital or for patients who have developed rehabilitation needs at home. The Day Hospital also offers specific facilities for therapies such as blood transfusion, thus avoiding the need for hospital admission.

We provide a liaison or consulting service to the whole Hospital, allowing close working relationships with other clinical teams to ensure the best possible care for all older people.

Training of future doctors, nurses and therapists is also an important function of the Elderly Care Department. There are close links with Queen’s University Belfast Medical and Nursing Schools. It is imperative to ensure that future health care professionals have all the skills necessary to treat older people appropriately, with respect and dignity.

Falls service

Falling is a common problem throughout our lifetime but as we get older the risk of injury from falls unfortunately gets higher. Physical injury, such as a fracture, can be one of the consequences of falling. Less obvious, but as important, is the worry and loss of confidence that can affect a person after a fall.

There are often medical reasons why people fall. Some are treatable. There are also ways to reduce the risk of injury associated with a fall.

Research shows that, for some people, specialist assessment and treatment can reduce the risk of falling by a third.

We provide a Specialist Multidisciplinary Falls Clinic and Falls Prevention Programme for selected patients. Assessment by a nurse, doctor, physiotherapist, pharmacist and occupational therapist identify reasons why a person might be at risk of falling and institute an individualised programme to reduce the future risk of injury and falls. Some people will be referred to a four-week Falls Prevention Programme consisting of educational sessions and group exercises to improve balance and strength.

The clinic is located in the Day Hospital, one morning per week.

Therapy Services / Specialist Nursing Services

Other Information

Dementia

Dementia – Dr Peter Passmore

Overview

Dementia refers to a loss of cognitive function (cognition) due to changes in the brain caused by disease or trauma. The changes may occur gradually or quickly; and how they occur may determine whether dementia is reversible or irreversible.

Cognition is the act or process of thinking, perceiving, and learning. Cognitive functions that may be affected by dementia include the following:

Dementia also may result in behavioural and personality changes, depending on the area(s) of the brain affected.

Types Some dementia is reversible and can be cured partially or completely with treatment. The degree of reversibility often depends on how quickly the underlying cause is treated.

Irreversible dementia is caused by an incurable condition (e.g., Alzheimer’s disease). Patients with irreversible dementia are eventually unable to care for themselves and may require round-the-clock care.

Incidence and Prevalence More than 20% of people over the age of 80 suffer from dementia. Five to eight percent of people over the age of 65 have some form of dementia and the number doubles every 5 years over age 65.

The prevalence of dementia has increased over the past few decades, either because of greater awareness and more accurate diagnosis, or because increased longevity is creating a larger population of elderly, which is the age group most commonly affected.

Risk Factors The greatest risk factor for dementia is advanced age.

Inheriting the genes associated with Alzheimers or Huntington’s disease is a risk factor. Untreated infectious and metabolic disease and substance abuse also can lead to dementia.

Other risk factors include the following:

Regional Osteoporosis Service

Osteoporosis is a disease characterised by low bone mass and structural deterioration of bone tissue leading to bone fragility and an increased susceptibility to low trauma fracture, especially of the wrist, spine and hip. It is a common disease. At some stage one in four women and one in twelve men will sustain an osteoporotic fracture. Although most of these people will be over 50 years, younger people can suffer from osteoporosis due to another disease.

Bone density can accurately be measured by Dual Energy X-Ray Absorptiometry. This technique uses low dose X-ray to assess bone density in the lumbar spine, hip and forearm.

Belfast City Hospital offers a comprehensive direct access bone densitometry service with a consultant report. Two specialist Osteoporosis Clinics take place every week.

The Department participates in research in osteoporosis, with an emphasis on drug compliance and safety, and also is involved in clinical trials of new osteoporosis drugs.

Patients who should be considered for referral include:

Women

Eighty percent of those affected by osteoporosis are women.

Osteoporosis is often called the "silent disease" because bone loss occurs without symptoms. People may not know that they have osteoporosis until their bones become so weak that a sudden strain, bump or fall causes a fracture or a vertebra to collapse. Collapsed vertebrae may initially be felt or seen in the form of severe back pain, loss of height, or spinal deformities such as kyphosis or stooped posture.

Certain people are more likely to develop osteoporosis than others. Factors that increase the likelihood of developing osteoporosis are called "risk factors." These risk factors include:

Women can lose up to 20% of their bone mass in the five to seven years following menopause, making them more susceptible to osteoporosis.

By about age 20, the average woman has acquired 98 percent of her skeletal mass. Building strong bones during childhood and adolescence can be the best defence against developing osteoporosis later. There are four steps, which together, can optimise bone health and help prevent osteoporosis. They are:

An osteoporosis helpline on (028) 9032 9241 Ext: 2114, operated by specialist nurses provides advice on prevention and management of osteoporosis drug therapies.