Seniors Health links PUK

British Society of Gerontology

Geriatric Medicine University of Virginia

Geriatric medicine: a brief history BMJ 1997

Search Medica Geriatric Resources

BBC News Elderly care dossier Nov 2011

iTU Advances in aging research University of Arizona

Geriatrics Rural Health West au


NSF older people

NSF Older people

NSF Older people


Elderly demographics

21stcenturychallenges.org/britains greying-population


Aging process



Characteristics of older people and their consequences for drug therapy NeLM Sep 2011


Prescribing in the elderly

Prescribing in the elderly


Functional assessment in older people

Functional assessment in older people BMJ Sep 2011

Disease presentation in elderly

Consult gerirn.org/topics/atypical_presentation/want_to_know_more


Long term care


Care At Home


Residential Care


Nursing and residential care homes

CQC Meeting the healthcare needs of people in care homes

British Geriatrics Society July 2011 – A quest for quality in care homes

iTunes U transitions into residential care epub OU


Prescribing in nursing and residential care homes

Medication FAQs for Care Home Staff


STOPP Criteria

NELM: Health Foundation report: Making care safer Jul 2011

Download Report

Medication FAQs for Care Home Staff

NELM: Health Foundation report: Making care safer Jul 2011

Download Report

Dosette and Venalink


Professional carers in care homes and community







Community nursing team

Community Nursing Team


Carers (relatives)

RCGP Carers Resources Jun 2011


Focus on Carers and the NHS-identifying and supporting hidden carers. Good Practice Guide

BMA Guidance on Working with Carers


Direct Gov

NHS Carer Information Strategies guidance – HDL22 (2006) (sections 3.3 and 3.10)

Scottish Enhanced Services Programme 2007 – services for carers

Carers Direct MHS Choices


Diet and nutrition in the elderly

www.dietetics.co.uk undernutrition in the elderly


Vitamin D in elderly


Vitamin D in Elderly @ Medscape

Vitamin D and the Elderly: Vitamin D, Falls and Fractures Medscape 2005


Vitamin D Supplementation Does Not Reduce Fall Rates Sep 2011

Advice from Rheumatology at Hope
If low serum vit d (D3) commence Adcal-D3 2 tabs od and recheck 3m
If still low consider -one off ergocalciferol 300 000 u IM or 20 000 u bd po for 5 days
be sure to check full bone profile PTH and coeliac serology


OA in the elderly

NICE CG59 OA Feb 2008


Osteoporosis elderly



Assessment pain in older people

Royal College of Physicians, British Geriatrics Society and British Pain Society



Hearing problems elderly

Hearing Problems AAFP

Communicating With Impaired Elderly Elderly Care Online


Visual problems lderly

Vision Problems in Aging Adults Cleveland Clinic

Common Causes of Vision Loss in Elderly Patients AAFP 1999


Constipation in the elderly

Constipation in the Elderly AAFP

Constipation in Elderly Medscape

ahealthstudy.com/ constipation elderly


Continence in the elderly

Urinary incontinence SIGN Guideline 79

Urinary Incontinence in the Elderly Medscape

Diagnostic Evaluation of Urinary Incontinence in Geriatric Patients



Mobility & falls

NICE CG21 Falls Nov 2004

NHS Information Centre June 2011

BMJ Postural Hypotension Jun 11

Fall assessment in older people BMJ Sep 2011

Nice Risk Assessment

RCP Fallsafe

Stay on your feet Western au


Leg ulcers




Pressure sores elderly


Pressure Ulcers Medscape

elderlycaretips.info Pressure Sores

rcn.org.uk pressure ulcer guidelines

howtocare.com/pressure sores


Influenza / flu vaccination in the elderly



Pensions and benefits for older people

Pensions including State Pension

Pension Credits

Winter Fuel Payments

Housing Benefit

dwp.gov.uk housing benefit

Carers Allowance Direct.gov

Attendance Allowance Direct.gov




direct.gov.uk Benefits/Concessions and other help

(EFIGM Bracewell Gray & Rai)
see also Benefits section


Driving regs elderly

DVLA Medical Advice AAG

A-Z guide for patients

GP must
inform the patient that he/she must contact the DVLA and his/her insurance company
complete the medical report requested by the DVLA, if there is consent
consider whether a patient is fit to drive while awaiting assessment
inform the DVLA if we consider there is a danger to the patient or others

Driving and dementia BMJ 2007 Risk is low in the first three years following onset of dementia


Cold weather

Cold Weather Plan 2011

Hypothermia in the elderly

AAFP 2004



Mental health elderly

NICE PH16 Mental wellbeing and older people Oct 2008



Depression & anxiety in the elderly

No evidence for efficacy of antiDs in elderly with dementia EEP Infopoems Jun 2011

Newer antidepressants less safe in the elderly BMJ Aug 2011

Depression in older adults BMJ Jul 2011


Alcohol in elderley

BMJ 2003 Alcohol Abuse Elderly


icap.org Alcohol and the Elderly


Alzheimers dementia confusion memory loss


CKS dementia

dh.gov.uk spotting the signs of dementia


Suspected early dementia Rational Imaging BMJ Sep 2011

Cognitive assessment of older people BMJ Sep 2011

mediacentre.dh.gov.uk dementia campaign

QOF Targets Dementia

Annual Review
BP, BMI, smoking status/cessation, assessment of falls & injuries, safety at home (Careline, alarms, Home-care), consider OT, physio, falls/balance assessment. Review repeat medication and co-morbidities.
Annual bloods depend upon co-morbidities rather than dementia.

Primary Prevention
ACE, statins or aspirin are not recommended for the primary prevention of dementia but control HT, DM, CVD risks according to NICE/Practice guidelines.

Secondary Prevention:
Treat CVD risks according to guidelines.
At the time of diagnosis and annually afterwards, assess medical and psychiatric co-morbidities, including depression and psychosis.

Acetylcholinesterase Inhibitors are prescribed by secondary care. They are licensed for those with Alzheimer’s disease of moderate severity (10-20 points on MMSE) or with scores >20 with moderate dementia judged by deterioration in social/functional ability. The patient will have at least 6 monthly reviews for functional and behavioural assessment, and are continued if there is evidence of benefit from clinician, patient or carer.
They are sometimes prescribed for Lewy body dementia with severe challenging behaviour where other methods are ineffective.

Antipsychotics/ benzodiazepines
These should be prescribed at the lowest dose for the shortest time, with close monitoring for effects. Remember the increased risk of cerebrovascular events with antipsychotic medication in mild behavioural problems with Alzheimer’s, vascular or mixed dementia. Those with Lewy body dementia can have severe adverse events. Antidepressants for those with dementia should be started by specialists.

Social Interventions
Carer support and assessment(Carer’s Connection Bradford, Alzheimer’s society, Making Space)
Community careHome care, day care, respite care.
Financial DLA (under 65), Attendance Allowance, Carer’s Allowance. Refer to below website CAB/DWP.
Lasting Power of Attorney property, affairs and personal welfare. Includes healthcare and treatment decisions.
Advanced decisions legally binding, can make treatment decisions about their future.
Making a will Alzheimer’s society can give details of solicitors with experience in dementia.
Driving DVLA & Insurance company must be informed. Their licence may be revoked/ limited, or need regular review.

Suspected Mild Cognitive impairment patients can be referred to memory clinic for assessment. Early diagnosis is emphasised by NICE in order to access resources for patient/carers, planning and medication.
Consider referral for:
Confirmation of diagnosis of dementia
Suitability for medication
Problematic behavioural/psychological symptoms
Risk assessment
Support for patient/carer



Mental Illness In Primary Care Mark Morris 2009 Radclife
Questions for Patient and relative/carer
Have you noticed any change in personality?
Have you noticed any increased forgetfulness?
Have any activities been give up? why?
Has there been any problems recognising people?
Have there been any difficulties with speech?
Have the changes been gradual or has there been sudden worsening?


Pharmacological: three cholinesterase inhibitors – mild to moderate Alzheimer’s disease: donezipil, rivastigmine and galantamine.

P Physical problems, like pain, may trigger behavioural change.
A Activities of others are annoying or frightening to the patient.
I Intrinsic features of dementia are appearing, like wandering.
D Depression underlies the behaviour change, or there are delusions/psychtotic symptoms


Dementia guidelines

NICE CG42 Dementia Nov 2006

NICE Update TA217 Alzheimers Dgugs Mar 2011

SIGN 86 dementia Feb 2006.

Antipsychotics & Behavioural Disturbance in the elderly

The Right Prescription: A call to action on the use of antipsychotic drugs for people with dementia’ Dementia Action Alliance June 2011


Pain and behavioural disturbance in dementia MeReC Aug 2011


MCA 2005

Mental Capacity Act BMJ Nov 2007

legislation.gov.uk MCA 2005


Enduring power of attorney

Enduring Power Of Attorney


Advanced directives

Advance decisions @ Alzheimers.org.uk


Dealing with relatives


stevepavlina.com/difficult relatives


EOL care GSF

Gold Standards Framework

rcgp end of life care

mcpcil.org.uk liverpool care pathway

GMC end of life care



Safeguarding adults

Vulnerable Adults May 2011

BMA Toolkit Jul 2011



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