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"Pollock, Lucy"
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The golden rule : lessons in living from a doctor of ageing
Today, we are living longer lives, and have choices now as never before about how we will age. What will make us happy? What are we frightened of, and what might allay those fears? What changes, made right now, will help us to flourish as we age? This book contains lessons I've learned from thirty years of working with older people and those close to them. It looks at problems that can be fixed with tests and tablets, and problems that require a different sort of medicine. I explain what I have been taught about loss, about impossible families, about becoming older without children, and the important things I have learned about sexuality, race, love, and living with uncertainty.
Book
Determinants of implementing deprescribing for older adults in English care homes: a qualitative interview study
ObjectivesTo explore the factors that may help or hinder deprescribing practice for older people within care homes.DesignQualitative semistructured interviews using framework analysis informed by the Consolidated Framework for Implementation Research (CFIR).SettingParticipants were recruited from two care home provider organisations (a smaller independently owned organisation and a large organisation) in England.ParticipantsA sample of 23 care home staff, 8 residents, 4 family members and 1 general practitioner were associated with 15 care homes.ResultsParticipants discussed their experiences and perceptions of implementing deprescribing within care homes. Major themes of (1) deprescribing as a complex process and (2) internal and external contextual factors influencing deprescribing practice (such as beliefs, abilities and relationships) were interrelated and spanned several CFIR constructs and domains. The quality of local relationships with and support from healthcare professionals were considered more crucial factors than the type of care home management structure.ConclusionsSeveral influencing social and contextual factors need to be considered for implementing deprescribing for older adults in care homes. Additional training, tools, support and opportunities need to be made available to care home staff, so they can feel confident and able to question or raise concerns about medicines with prescribers. Further work is warranted to design and adopt a deprescribing approach which addresses these determinants to ensure successful implementation.
Journal Article
Bushfire Smoke Exposure, Asthma and Pregnancy: The Smoke Is Yet to Clear
Background: Bushfire smoke exposure (BFSE) is associated with adverse pregnancy and neonatal outcomes; however, the specific impact of BFSE on pregnancies complicated by asthma is not well characterised. Methods: A retrospective cohort study analysed data from 22,166 pregnant women who gave birth in the Illawarra Shoalhaven region between January 2017 and December 2022. Women with asthma were identified by the ICD-10-AM code for asthma during hospital admission for birth. Exposure was defined using a fixed time-window assumption. Women were considered exposed to bushfire smoke if they experienced at least 4 weeks of their pregnancy between 25 October 2019 and 4 February 2020. Results: Prevalence of asthma in the total population was 8.31%. In the control cohort, outcomes for pregnant women with asthma were poorer than those without. Pregnant women with BFSE had increased odds of postpartum haemorrhage (OR 1.603; 95% CI 1.42–1.81), and decreased odds of gestational hypertension (OR 0.615; 95% CI 0.49–0.77), gestational diabetes mellitus (OR 0.703; 95% CI 0.63–0.79) and preterm birth (OR 0.813; 95% CI 0.67–0.98). Maternal asthma did not confound the relationship between BFSE and any of the primary study outcomes. Conclusions: This study emphasises the independent effects of asthma on pregnancy outcomes. The impact of BFSE on pregnant women with asthma remains unclear. Further research is needed to characterise the true effect of BFSE on pregnancies, uncomplicated and complicated by asthma.
Journal Article
Frailty for neurologists: a practical guide
Neurologists increasingly care for people with significant frailty in both clinic and ward settings. Such care demands a balanced approach to investigation, diagnosis and treatment, as well-intentioned actions can produce adverse effects. This article presents a practical approach to the identification and management of patients with frailty and neurological conditions. We address medicines optimisation, common causes of deterioration in those with frailty, communication, decisions about intensity of treatment, and shared decision-making including ethical aspects of withholding or withdrawing life-prolonging treatment, with a view to improving the experience both of people living with frailty and of the teams who care for them.
Journal Article
Understanding stakeholders’ perspectives on implementing deprescribing for older people living in long-term residential care homes: the STOPPING study protocol
Background
Older people with multimorbidity often experience polypharmacy. Taking multiple medicines can be beneficial; however, some older adults are prescribed multiple medicines when they are unlikely to improve clinical outcomes and may lead to harm. Deprescribing means reducing or stopping prescription medicines which may no longer be providing benefit. While appropriate deprescribing may usually be safely undertaken, there is a lack of guidance about how to implement it in practice settings such as care homes. Implementing deprescribing in care homes is often challenging, due to differing concerns of residents, staff, clinicians, friends/family members and carers along with differences in care home structures. The STOPPING study will support the development of better deprescribing practice in care homes, considering different views and environments. This paper aims to introduce the research protocol.
Methods
We will use qualitative approaches informed by the widely accepted Consolidated Framework for Implementation Research (CFIR) to aid analysis. To understand the barriers, facilitators, and contextual factors influencing deprescribing in care homes, we will employ individual interviews with care home residents and family members, focus groups with care home staff and healthcare professionals, and observations from care homes. Then, we will examine acceptability, feasibility, and suitability of existing deprescribing approaches using cognitive interviews with care home staff and healthcare professionals. Lastly, we will use narrative synthesis to integrate findings and develop guidance for implementing a deprescribing approach for care homes.
Discussion
This research will support the development of implementable approaches to deprescribing in care homes. The insights from this project will be shared with various stakeholders: care home residents, staff, pharmacists, general practitioners, nurses, and other health professionals, carers, researchers, and the public. This work will support deprescribing to be implemented effectively in care homes to benefit residents and the wider health economy.
Journal Article
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
Journal Article
Recurrent syncopal events preceded by transient abnormal gait disturbance
A previously fit and well patient in his 70s presented after recurrent transient loss of consciousness following dinner with alcohol consumption. Each event has been preceded by several minutes of transient abnormal posture and gait. More specifically, there were several minutes of stiffening of legs, shuffling gait and gait ataxia. Initial clinic investigations, including ECG, echocardiogram, CT and MRI head scans, vestibular tests and biochemistry for vitamins and electrolytes, proved inconclusive. However, a positive tilt table test demonstrated severe orthostatic hypotension (OH) with loss of consciousness.Acute alcohol consumption worsens OH, and prolonged hypotension can potentiate cerebral hypoperfusion leading to syncopal events. Compromise to posterior circulation during these events may cause transient gait abnormalities. Such cases have not been widely documented in the literature. Transient gait disturbance in syncope remains underexplored. Further research and documentation are needed, informing better diagnostic and management strategies.
Journal Article
Quality of life after in-hospital cardiopulmonary resuscitation for patients over the age of 80 years
ObjectivesSuccess of in-hospital resuscitation decreases with age; however, national data show that 11.3% of patients over 80 years survive to discharge. There are few published qualitative data about the quality of life for these patients postsuccessful resuscitation. We aimed to investigate postresuscitation quality of life in patients over the age of 80 through a series of case studies.MethodsAll patients over the age of 80 years, who received cardiopulmonary resuscitation (CPR) at our district general hospital in 2015–2016, were included. Success of resuscitation, survival at day 1 and to discharge were recorded. For patients who survived to 1 day and beyond, case reports were written to create individual patient stories.Results47 patients over the age of 80 years received CPR at Musgrove Park Hospital over a 2-year period. Five (10.6%) survived to discharge. Of those surviving to discharge, two had substantial functional decline, requiring discharge to nursing homes having previously been independent. Of the five families/patients who commented on their experience, only one expressed a positive view. When discussed, the majority of patients/families opted for a Do Not Attempt CPR.ConclusionOur results have shown that there is a risk of substantial functional decline associated with successful CPR in those patients over the age of 80 years. The majority of patients and relatives contacted after successful resuscitation expressed a negative view of the experience. Our study highlights the importance of having early informed discussions with patients and families about CPR in order to avoid detrimental outcomes and ensure patient wishes are correctly represented.
Journal Article
School Experiences of Gypsy, Roma and Traveller Children : an Exploration of Psychological Sense of Community
This thesis explores school experiences of Gypsy, Roma and Traveller (GRT) children and is comprised of three chapters: a systematic literature review, a bridging document, and an empirical research project. The systematic literature review explores GRT children’s experiences of school inclusion. An interpretive qualitative synthesis approach, meta-ethnography, was adopted to analyse five recent papers. Findings suggest commonalities in school experiences of prejudice and the perceived purposelessness of education. Experiences of relationships with adults, social integration and cultural appreciation varied. These five constructs offer a starting point for understanding barriers to participation and experiences that support social inclusion in schools for GRT children. The bridging document aims to link the meta-ethnography and the empirical research project. This chapter discusses the rationale for the thesis, including underpinning ontological and epistemological assumptions and the implications for the chosen methodology. Consideration is also given to ethics, quality and rigour during the research project. The empirical report explores GRT children’s experiences of school using the theoretical lens of Psychological Sense of Community. A qualitative approach was adopted. Six individual semistructured interviews were transcribed and analysed using Thematic Analysis. Psychological Sense of Community is postulated to involve four elements and these were used as a deductive framework, whilst themes were constructed inductively from the data itself. Findings suggest specific, cultural factors which impact on the experience of Psychological Sense of Community for GRT children. Many appear to experience a sense of belonging to a sub-community of GRT children within the wider school community. It is concluded that Educational Psychologists may find Psychological Sense of Community helpful in exploring the cultural nuances involved in promoting inclusive practices for GRT children in schools.
Dissertation