Proactive frailty in primary care: A primary care system fit for frailty.

Older adults with frailty are at increased risk of premature death, and numerous negative sequalae including falls, disability, and dementia alongside increased healthcare costs. Most healthcare interactions for older people with frailty take place in primary care, and there is increasing interface working between primary and secondary care to manage this patient group including virtual wards, frailty management programmes and Hospital @ Home. This commentary aims to place proactive frailty into recent policy perspective, alongside highlighting some of the current challenges around the implementation of proactive frailty programmes.

Understanding the processes behind the decisions - GPs and complex multimorbidity decision making.

Complex multimorbidity, defined either as three or more chronic conditions affecting three or more different body systems or by the patients General Practitioner (GPs), is associated with various adverse outcomes. Understanding how GPs reach decisions for this complex group of patients is currently under-researched, with potential implications for health systems and service delivery. Schuttner and colleagues, through a qualitative approach, reported that internal factors of individuals (decisions tailored to patients; Primary Care Physician (PCP) consultation style; care planning towards an agreed goal of care), external factors within the environment or context of encounter (patient access to healthcare; organizational structures acting as barriers), and relationship-based factors (collaborative care planning; decisions within a dynamic patient clinician relationship) all influence care planning decisions.

Changes in clinical manifestation of fibromyalgia syndromes after Alzheimer's disease diagnosis.

Fibromyalgia syndrome (FMS) is defined by chronic widespread pain persisting for more than 3 months without an apparent physical cause. The prevalence of FMS peaks between 50 and 70 years old, and it can be difficult to diagnose and treat due to other comorbid conditions. Recent work has suggested that neurodegenerative conditions can be complicated by chronic pain.

Assessment and treatment of depression associated with dementia.

Depression is a frequent diagnosis for people with dementia, with between 25% and 42% of such patients receiving antidepressants. The diagnosis can be challenging to make, and this patient group is more vulnerable to side effects of commonly used medications. This article outlines the diagnostic considerations and therapeutic approaches for managing depression in people with dementia.

Causes and correlates of 30 day and 180 day readmission following discharge from a Medicine for the Elderly Rehabilitation unit.

Background: Recently hospitalized patients experience a period of generalized risk of adverse health events. This study examined reasons for, and predictors of, readmission to acute care facilities within 30 and 180 days of discharge from an inpatient rehabilitation unit for older people.

Methods: Routinely collected, linked clinical data on admissions to a single inpatient rehabilitation facility over a 13-year period were analysed.

Incidental hip fracture in an outpatient clinic: the importance of patient-centred assessment.

Although many patients presenting with hip fractures have classic symptoms, other patients may present atypically with referred knee pain and reasonably unremarkable clinical examination following initial presentation. Older patients commonly have comorbid conditions such as arthritis, stroke and dementia that can complicate history and examination, making the diagnosis of subtle fractures difficult. Multimorbidity represents an important diagnostic challenge to both primary and secondary care.

Primary care hypnotic and anxiolytic prescription: Reviewing prescribing practice over 8 years.

Introduction: Over the last few years, hypnotic and anxiolytic medications have had their clinical efficacy questioned in the context of concerns regarding dependence, tolerance alongside other adverse effects. It remains unclear how these concerns have impacted clinical prescribing practice.

Materials And Methods: This is a study reviewing community-dispensed prescribing data for patients on the East Practice Medical Center list in Arbroath, Scotland, in 2007, 2011 and 2015.

Association between bisphosphonate therapy and outcomes from rehabilitation in older people.

Background: Bisphosphonate therapy may have actions beyond bone, including effects on cardiovascular, immune and muscle function. We tested whether bisphosphonate treatment is associated with improved outcomes in older people undergoing inpatient rehabilitation.

Methods: Analysis of prospectively collected, linked routine clinical datasets.

Psychoactive prescribing for older people--what difference does 15 years make?

Objective: The objective of the study was to review prescribing of psychoactive medications for older residents of the Tayside region of Scotland.

Methods: The analysis used community prescribing data in 1995 and 2010 for all older residents in Tayside. For each psychoactive drug class, the name of the most recently prescribed drug and the date prescribed were extracted.

The transplant patient and transplant medicine in family practice.

Over the last two decades in particular there has been a remarkable increase in the number of solid organ transplants being performed worldwide alongside improvements in long-term survival rates. However, the infrastructure at transplant centres has been unable to keep pace with the current volume of the transplant patient work load. These pressures on transplant specialist centres has led to calls for an increased role of the general practitioner (GP) managing particular aspects of transplant patients' medical care.

Guidelines for people not for diseases: the challenges of applying UK clinical guidelines to people with multimorbidity.

Background: currently one of the major challenges facing clinical guidelines is multimorbidity. Current guidelines are not designed to consider the cumulative impact of treatment recommendations on people with several conditions, nor to allow comparison of relative benefits or risks. This is despite the fact that multimorbidity is a common phenomenon.

Assessment and management of pain in older patients receiving palliative care.

This article aims to outline the principles that underpin good practice in the assessment and management of pain syndromes in older patients with advanced, life-limiting illnesses. Older patients receiving palliative care can be nursed in a variety of settings, including acute hospitals and in the community either at home, in nursing homes or hospices. An understanding of pain and approaches to treating it will help ensure that nurses in different clinical settings are able to support patients receiving palliative care and their families.