Editor’s view

Editor’s view Age and Ageing 2018; 47: 157 © The Author(s) 2018. Published by Oxford University Press on behalf of the British Geriatrics Society. doi: 10.1093/ageing/afx204 All rights reserved. For permissions, please email: journals.permissions@oup.com With all the challenges in providing safe and effective care for Z-drugs, falls and fractures an ageing population, quick and simple solutions have an imme- Z-drugs such as Zopiclone are commonly promoted as diate allure. Healthcare checklists are often proposed as a simple safer alternatives (compared to benzodiazepines) for the means to ensure that the correct actions are performed rou- treatment of insomnia in older people. In a systematic tinely, driving up standards of care with better clinical outcomes review, Perlman et al. show these drugs are associated with and reduced risk of harm. The example of improvements in increased risk of fracture, which is likely to be mediated safety from use of this approach in the aviation industry is often through increased falls. This study gives further reason for cited, with the inference that we can expect similar benefits clinicians to recommend non-pharmacological strategies as from use of checklists in healthcare. However, evaluation studies the mainstay for management of insomnia in older people. have provided conflicting results, and it is clear that these tools are not as simple or effective as initially hoped. In this issue of the journal, Papoutsi et al. report a quali- Self-care tative study of Frailsafe, a checklist that aims to enhance recording of frailty and reduce risk of harms for older peo- In an exploratory systematic review, Wong et al. report on the ple admitted acutely to hospital. The findings were very dis- available evidence for a variety of complex interventions appointing. In short, the checklist often was not completed designed to enhance self-care of older people. The interventions and there was no evidence that its introduction facilitated included a wide range of approaches including case manage- change. Identified barriers included rigidity of existing sys- ment, individualised care plans (developed after Comprehensive tems and communication patterns. Overlap with other Geriatric Assessment) and goal planning in rehabilitation. The assessments was noted, which may have contributed to a effects on range of health-related outcomes were generally posi- reluctance of staff to engage. tive with improved self-rated health and aspects of health- These results are not surprising. There is an extensive litera- related quality of life, however, there were no improvements ture which shows that complex cultural and organisational seen in mood, basic or extended activities of daily living, and no changes are generally required to improve the quality and safety impact on hospital or care home admission. Studies generally of healthcare—and while checklists can play a part, introduc- excluded those with cognitive impairment. tion of a checklist on its own is unlikely to have much effect. Enhancing self-care should play a part in geriatric assess- In addition to the above, this issue of Age and Ageing ment and rehabilitation—when patients are capable and contains a wide range of informative articles. willing to take this on. This approach can provide subjective benefits for older patients, however, it is unlikely that it will reduce the need for health and social care support. Increasing medication use in later life Supported hospital discharge In a report from the UK Cognitive Function and Ageing Studies, Gao et al. report the extraordinary increases in In a randomised controlled trial from New Zealand, Parsons medication use in the over-65s over a 20-year period from et al. show that supported discharge of older hospitalised peo- 1991 to 2011. Over this period, the percentage of older ple reduces length of hospital stay and reduces cost of care. people taking five or more items increased more than The intervention comprised a home-based rehabilitation pro- 4-fold—from 12 to 49%. gramme, with sessions up to four times per day for up to 6 In an accompanying Editorial, Mangoni points out that weeks, delivered by trained healthcare assistants under the the association between number of long-term conditions and guidance of registered nurses. An important point to empha- medication use suggests an increasing adherence to clinical sise is that all patients were assessed for suitability by a con- guidelines. However, such guidelines have been generally sultant geriatrician—it seems likely that careful selection of developed for single pathologies, and may not be applicable those suitable for early supported discharge is vital for such to the frail patient or those with complex multimorbidity. schemes to operate safely and effectively. The results of this Furthermore, the evidence for many drugs concentrates on study are largely confirmatory, however, they reinforce the short-to-medium term benefit in terms of disease endpoints, potential role that well-organised post-discharge support has rather than the typical patient priorities of long-term quality in managing the ever-increasing demand for hospital beds. of life and maintenance of independence. Mangoni argues for a patient-centred approach to prescribing—a philosophy DAVID J. STOTT that should lie at the heart of good clinical practice. Email: david.j.stott@glasgow.ac.uk Downloaded from https://academic.oup.com/ageing/article-abstract/47/2/157/4903270 by Ed 'DeepDyve' Gillespie user on 16 March 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Age and Ageing Oxford University Press

Editor’s view

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Oxford University Press
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© The Author(s) 2018. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com
ISSN
0002-0729
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1468-2834
D.O.I.
10.1093/ageing/afx204
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Abstract

Age and Ageing 2018; 47: 157 © The Author(s) 2018. Published by Oxford University Press on behalf of the British Geriatrics Society. doi: 10.1093/ageing/afx204 All rights reserved. For permissions, please email: journals.permissions@oup.com With all the challenges in providing safe and effective care for Z-drugs, falls and fractures an ageing population, quick and simple solutions have an imme- Z-drugs such as Zopiclone are commonly promoted as diate allure. Healthcare checklists are often proposed as a simple safer alternatives (compared to benzodiazepines) for the means to ensure that the correct actions are performed rou- treatment of insomnia in older people. In a systematic tinely, driving up standards of care with better clinical outcomes review, Perlman et al. show these drugs are associated with and reduced risk of harm. The example of improvements in increased risk of fracture, which is likely to be mediated safety from use of this approach in the aviation industry is often through increased falls. This study gives further reason for cited, with the inference that we can expect similar benefits clinicians to recommend non-pharmacological strategies as from use of checklists in healthcare. However, evaluation studies the mainstay for management of insomnia in older people. have provided conflicting results, and it is clear that these tools are not as simple or effective as initially hoped. In this issue of the journal, Papoutsi et al. report a quali- Self-care tative study of Frailsafe, a checklist that aims to enhance recording of frailty and reduce risk of harms for older peo- In an exploratory systematic review, Wong et al. report on the ple admitted acutely to hospital. The findings were very dis- available evidence for a variety of complex interventions appointing. In short, the checklist often was not completed designed to enhance self-care of older people. The interventions and there was no evidence that its introduction facilitated included a wide range of approaches including case manage- change. Identified barriers included rigidity of existing sys- ment, individualised care plans (developed after Comprehensive tems and communication patterns. Overlap with other Geriatric Assessment) and goal planning in rehabilitation. The assessments was noted, which may have contributed to a effects on range of health-related outcomes were generally posi- reluctance of staff to engage. tive with improved self-rated health and aspects of health- These results are not surprising. There is an extensive litera- related quality of life, however, there were no improvements ture which shows that complex cultural and organisational seen in mood, basic or extended activities of daily living, and no changes are generally required to improve the quality and safety impact on hospital or care home admission. Studies generally of healthcare—and while checklists can play a part, introduc- excluded those with cognitive impairment. tion of a checklist on its own is unlikely to have much effect. Enhancing self-care should play a part in geriatric assess- In addition to the above, this issue of Age and Ageing ment and rehabilitation—when patients are capable and contains a wide range of informative articles. willing to take this on. This approach can provide subjective benefits for older patients, however, it is unlikely that it will reduce the need for health and social care support. Increasing medication use in later life Supported hospital discharge In a report from the UK Cognitive Function and Ageing Studies, Gao et al. report the extraordinary increases in In a randomised controlled trial from New Zealand, Parsons medication use in the over-65s over a 20-year period from et al. show that supported discharge of older hospitalised peo- 1991 to 2011. Over this period, the percentage of older ple reduces length of hospital stay and reduces cost of care. people taking five or more items increased more than The intervention comprised a home-based rehabilitation pro- 4-fold—from 12 to 49%. gramme, with sessions up to four times per day for up to 6 In an accompanying Editorial, Mangoni points out that weeks, delivered by trained healthcare assistants under the the association between number of long-term conditions and guidance of registered nurses. An important point to empha- medication use suggests an increasing adherence to clinical sise is that all patients were assessed for suitability by a con- guidelines. However, such guidelines have been generally sultant geriatrician—it seems likely that careful selection of developed for single pathologies, and may not be applicable those suitable for early supported discharge is vital for such to the frail patient or those with complex multimorbidity. schemes to operate safely and effectively. The results of this Furthermore, the evidence for many drugs concentrates on study are largely confirmatory, however, they reinforce the short-to-medium term benefit in terms of disease endpoints, potential role that well-organised post-discharge support has rather than the typical patient priorities of long-term quality in managing the ever-increasing demand for hospital beds. of life and maintenance of independence. Mangoni argues for a patient-centred approach to prescribing—a philosophy DAVID J. STOTT that should lie at the heart of good clinical practice. Email: david.j.stott@glasgow.ac.uk Downloaded from https://academic.oup.com/ageing/article-abstract/47/2/157/4903270 by Ed 'DeepDyve' Gillespie user on 16 March 2018

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Age and AgeingOxford University Press

Published: Mar 1, 2018

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