Eileen Burns
@EileenBurns13
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Physician. Recent National Specialty Advisor Older People. Previously President British Geriatrics Society
Leeds, Yorkshire, England
Joined November 2012
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In other news, I have just finished knitting an Aran jumper which has been on the needles for 11yrs!!!
#winningatlockdown
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Another "challenging" (ie terrible) day for patients especially, but also staff in NHS hospitals. How much longer can staff cope a river of inflow and a intermittent trickle of outflow. When will someone recognise that if we don't fund social care the NHS will fail?
@SteveBarclay
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Why is the NHS logo on this message?
We know people want to be with friends and family over Christmas🎄
Between 23 and 27 December, you can form an exclusive ‘Christmas bubble’ of up to three households 🎁
This applies across the UK.
More information ⬇️
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My closest (ahem) followers may have noticed my absence over the last 4 weeks. I've been secret shopping the NHS and have to say it's bloody brilliant esp when you are proper poorly
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Thanks to everyone who's worked / supported/ consoled/ celebrated with me over the last four years. I hope we've made progress in advancing healthcare of older people
@GeriSoc
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I'm so concerned that, exhausted from dealing with Covid, we've all taken our eye off the ball on this. We need a real push to remind all of us of the importance of avoidance of deconditioning
@GeriSoc
We *all* have a duty to prevent
#deconditioning
in hospitalised older people.
Here's how!
For free full chapter click link😀
#rehabilitation
@GeriSoc
@betterageing
@BrianwDolan
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Lovely afternoon at Buckingham palace at the invitation of Prince Charles (patron of BGS)...along with 6,000 or so other lucky people!
@GeriSoc
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So many older people spend their precious time going to multiple appointments with diminishing returns for them. Need to turn round our systems to meet our patients needs.
Greater specialisation, especially for hospital based doctors, has improved our ability to treat single diseases, but unless we react to the increase in multimorbidity it will disadvantage those patients with multiple seemingly unrelated diseases
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They said no selfies but I grabbed a quick one- not too flattering of the old lady but the queen looks good! Congratulations
@RCPLondon
@DacreJane
@RoyalFamily
@GeriSoc
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I've been so lucky to work in such a rewarding specialty with amazing colleagues. Still planning to keep sticking my oar in here and there! Thanks
@ali_cracknell
@sean9n
@sherena_nair
@grahamsutt
@Annawinf
and loads of other fabulous people who made today so special.
Emotional day
@LeedsHospitals
and
@LTHT_SIM
as the inspirational, brilliant, fun, dynamic, role model
@EileenBurns13
retires after a 42yrs career dedicated to improving older people's care. You will be missed
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I sometimes wonder if she's ever seen a geriatrician.
The queen 👸🏼🇬🇧needs a better AHP workforce. Wrong size walking stick and no perching stool for the balcony = Too tired to go to St Paul’s tomorrow 🙄
#fatiguemanagment
@SuzanneRastrick
@KMiddletonCSP
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Not only are staff tired, but the need to restart urgent non-Covid care means fewer resources (staff of all kinds, beds etc etc) available. Agree horrible sense of impending second wave, hope I'm wrong.
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Although we (med tweeters) know this, it's good to be reminded that delirium is associated with a 7 fold increase in subsequent dementia risk and 4 fold increase in mortality
#rcpeOlderMed22
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Absolutely right. After my Dad was made redundant from Consett Steel works he moved to Leeds to become a hospital porter (apprentice trained fitter and turner jobs being very hard to come by in the early 1980's). He loved his new job and I was (and remain) so proud of him.
NHS porters are the backbone of hospitals. Many have a story to share. I know Porters who are ex- military, retired police officers, those in recovery & people who genuinely want to care as a chosen career. Too often Porters are looked down on & today, I want to say thank you💙
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1. How many of us would be prepared to do this? One of our local homes, care staff ranks depleted by (belatedly available) positive (asymptomatic) staff needing to self isolate. Remainder of the staff team moved in for two weeks to ensure residents needs were met. Dedication
Incredible to hear staff in
#Cheddar
moved into the
#carehome
they work in to keep residents safe; away from loved ones for 3 mths & living in store cupboards. So much brilliant care given across the county.
@BorisJohnson
shame on you for your words, yet again not chosen wisely.
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Those who aren't geriatricians can assume that CGA is an assessment process, whereas the initiated are aware that CGA is a multidimensional assessment process with actions. I think the key part of the message is "actions"
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As usual the great
@MichaelMarmot
on
@BBCr4today
explaining clearly how worsening health inequalities have been accelerated by pandemic, and how drastic and regressive social care funding cuts have been. Action? Solution isn't medical it's political
@BolaOwolabi8
@michaelgove
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Years of underfunding and absence of a workforce plan means the NHS went into the pandemic understaffed and underfunded. This is a graphic description of the impact on one senior nationally recognised doctor. Something has to change.
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Helen's Mum allowed her daughter to use her photo at
#UKFrailtyconf
provided we ensure she goes viral! Go to it Twitter!
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Many of us who have worked with PA's as valued MDT members have been outraged by some frankly unprofessional attacks on those in this role, usually by anonymous accounts.
When supervised, and working within their competence and legal framework I feel they augment the medical team
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Older People hospital uselast year of life. 1 in 6 had =/>five admissions, 1 in 4 stayed for a month or more...of those precious last 12 (or less). Could we deliver care more effectively and humanely... almost certainly.
@ProfCNicholson
@premzf
@GeriSoc
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Gulp! Just changed my profile to "Past President" . Good luck
@TashMasud
, it's a great job and you have an excellent team
@GeriSoc
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Leeds Virtual MDT supporting care homes with Covid outbreaks. Created by several including
@andreamann7
@sean9n
@cath_roff
@JoHarding11
@drgdubya
If you can't read it DM me!
@adamgordon1978
@Dochayter
@BolaOwolabi8
@asanakpan
@EstherClift
@belliesleeds
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Not a diagnosis, not a disease...not even a word!
@stevemur67
Okay I’m calling it: this is 💯% unacceptable to me as a GP.
ED house officers this is not a diagnosis or a disease.
PS: Pray you never have to defend something like this in a courtroom.
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Good that care homes staff are being regularly tested. Why aren't we ensuring that carers of frail older people in their own homes are tested in the same way? Many of their clients are just as frail as care home residents
@Car_Abrahams
@ShelaghFogarty
@adamgordon1978
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Yes, so far (thankfully) small numbers. Also staff with proven Covid a month after first jab. Don't be lulled into a false sense of security. Second doses need to be given asap - as near to the evidential schedule as possible.
One month into the care home vaccination programme, I am deeply concerned to be seeing covid-19 infection outbreaks among first dose vaccinated residents within, and beyond 21 days of vaccination.
Are any other clinicians seeing this happening?
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The plan for the future of the NHS must include a move to more primary and community care for frail older people. Here's why and how!
@GeriSoc
The British Geriatrics Society calls for a reform of primary care to deliver better healthcare and treatment for older people. Download our position statement here:
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@jupiterhouse1
Unfulfilled promises that PPE would arrive, confusing and contradictory advice, chaotic testing processes, and all of this on a background of years of underfunding and lack of respect. Agree I have been amazed by the dedication and bravery of care homes managers and staff.
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AMost patients in hospital with Covid_19 are cared for in general wards. Staff outside ICU are not routinely protected from inhalation of infective particles as they care for patients on Covid wards. This must change urgently
@mancunianmedic
@LTHT_People
@stevieb68
@philwoodLTHT
Donna Kinnair said: “Nursing staff and all healthcare professionals need urgent reassurance from government ministers and scientists that they are sufficiently protected from the new variant both by PPE and safety procedures in their place of work."
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Fabulous afternoon celebrating
@turner_gill
's career as she retires from clinical work. Marked with the only possible cake...
@premzf
@EstherClift
and others - what a beautiful event.
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Recurring theme. Doctors can't/ won't see the wood for the trees when frail older people approach the end of life. Lack of recognition means lack of access to services you need
@DanLasserson
@DrCarolineN
@GeriSoc
Recognition of the end of life in out of hours primary care - our paper out today shows that 33% of people who die are seen by an out of hours GP in the 30 days before death - only a 1/3 of people who die are recognised to be at the end of life
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Thank you!
Sending our congratulations to BGS Past President
@EileenBurns13
on being awarded an MBE in the
#NewYearsHonoursList
for services to Integrated Healthcare for Older People. Well done and much deserved Eileen!
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How will "named clinical lead" for every care home work with residents registered with many different GP practices? Is it time for UK to adopt the US "Medical Director" or Netherlands "Elderly Care Physician"?
@adamgordon1978
@MattHancock
@KeebleM
@HDEMCOP
@GeriSoc
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And consultants as well!
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Even though we know hospital is not safe for frail older people.
More likely to:
1. Fall
2. Be delirious
3. Be malnourished
4. Decondition
etc, etc.
Home first - make it a reality not just a slogan!
But you're absolutely right that "another 24hrs" is often a tempting option.
@DrLKVaughan
Discharging people is much harder than admitting them. Even at the end of the PTWR, when I’m tired, I tend to go with the easiest option which is generally to continue the plan and review tomorrow! We get decision fatigue and go with what feels safest and easiest
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We need to start planning rehab facilities on the same scale as our amazingly rapidly developed Nightingale Hospitals
@adamgordon1978
@GeriSoc
@geri_baby
The dark side of ventilators. Hundreds of survivors will be left with physical and psychological scars - The Washington Post
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Did you know the 30 day survival rate for those 80 yrs of age or more after out of hospital cardiac arrest is 2-4%? And that the survival rate free of brain damage is 2%? Makes you think, doesn't it?
#EuGMS
in Krakow
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Over 50% of hospital inpatients are over 75; not every patient can be "TCI med eld" unless 50% of other specialists are volunteering for redundancy. Even if you're not going to have an operation or intervention you still need specialist care
#medicsnottechnicians
If you refuse to take an appropriately referred patient, demand the emergency department then refer elsewhere, then demand the other specialty consultant ring your consultant to explain why they won’t take your rejected referral. You can kindly fuck off.
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Can we please remember that our PA colleagues are part of our MDTs. Those I have worked with provide a great contribution to the team giving patient care. Yes, there are important issues with regard to regulation, scope of practice,
Members and Fellows of
@RCPhysicians
, who's interested in co-signing a letter to the College to ask for an urgent debate about Physician Assistants? Reply to this and I'll DM you the link.
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Sir Chris Ham, an expert on health policy from his years leading the
@TheKingsFund
and in practical management of services through his roles with NHS trust board and ICS speaking truth...to those in power. But are they listening
@sajidjavid
?
it saddens me to write this piece but the NHS is falling over with extreme stress in general practices, hospitals, the ambulance service, etc
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Catching up on my reading- a really important clarification and prompt to support avoiding inappropriate antibiotic prescribing for non- existent "UTI" - focus here on care homes but the message is applicable more widely.
@sean9n
@SpillersK
@adamgordon1978
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Thanks
@BBCr4today
@Marthakearney
for interviewing the erudite Prof Sir Andrew Dilnot on the scandalous neglect of social care by successive governments.We need to make our voices heard - this isn't a "fringe"!issue
@mancunianmedic
@RichardnotatKF
@cath_roff
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Is specialism and sub-specialism the inevitable consequences of modern medicine's extended possibilities or an extreme example of vested interests trumping population health needs? As a Geriatrician I know what I think!
Patients increasingly have multiple conditions, while doctors continue remorseless specialisation and subspecialisation. What are the consequences of this divergence? asks
@Richard56
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Excellent quote to start Amit's talk on avoiding deconditioning
#endPJparalysis
@betterageing
#BGSconf
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So grateful for a day off today after the last 3 incredibly busy days. Massive respect to my colleagues (clinicians and managers) working full time (plus on calls)- at the moment more than ever. Try to squeeze in a walk in the park if you can.
@sean9n
@ali_cracknell
@ClareLSmith
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Many of whom are older...if only we were training enough geriatricians for A&E interface and acute frailty roles...
@GERED_DOC
@GeriSoc
80% of trusts say higher levels of patients with more complex conditions are having biggest impact on A&E
#QMR22
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Spread the message- older people are the core users of the NHS and need competent clinicians. Geriatricians can't do it all.
#sharetheskills
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#NHS75
I've worked in the NHS for 42 years, 31 of them as a consultant geriatrician. There have been peaks and troughs over that time (not least (obviously) COVID). But I can definitely say I have confidence in those colleagues to whom I have handed the baton
#fightthegoodfight
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No Laura, unfortunately not. Two big problems with social care funding: unfairness (which this tackles) & substantial underfunding, which this doesn't address. Social care staff need NHS Agenda for Change wages & funding needs to reflect appropriate staffing, wages, environment..
Is there finally a solution for social care in sight? Maybe... important clues about what ministers were planning just before the virus hit
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Over 90 internationally acclaimed speakers will showcase pioneering developments at Innovation in Medicine 2018. See here just some of the world renowned speakers presenting their latest findings
#IMed2018
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A privilege to speak at
#BGSconf
this afternoon on supporting frail older people out of hospital in times of Covid. Importantly but not only end of life care.
@GeriSoc
@premzf
@ProfCNicholson
#bgseolsig
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Roses are red
Violets are well, actually violet
Unless we die young
We're all going to be old.
We Need A Plan
For a society that promotes healthy ageing and provides health & social care that meets our needs as we age.
An older people's strategy!
@NHSEngland
@GeriSoc
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We know the risks - deconditioning, falls, delirium, poorer nutrition, pressure injury...and we know that "warehousing" people in "discharge to assess" beds where they disappear from any statistics (it seems) isn't the answer.
We must raise awareness of the detrimental effects on older people of being stuck in hospital when 'medically fit for discharge'. Every day older patients across the country are waiting for packages of care that never come.
#BGSTimelyDischarge
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Despite years of posting on important issues on health and care of older people my most re-tweeted (I know, old money) post was about my Aran jumper, completed after 12 yrs on the needles.
But it's true, my office has never been so tidy as when doing mandtory training.
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Discharge HOME to assess would be a great service. Discharge to a care home (with a high likelihood of further deconditioning with increased need for social care to wait for someone, somewhere to remember you're there and do something about it is a terrible service.
@HPIAndyCowper
Yep and we (
@GeriSoc
) warned
@RishiSunak
of the folly of that decision plunging
@NHSEngland
into its present log jam flow crisis..but the true villains of the piece are those (now departed I hear) who ensured D2A did nothing more than park the road block 6 weeks down the road 🤷♂️
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End de-conditioning in the NHS! It's a social movement- and so important
Addenbricks have done it again! Another fab
#endPJparalysis
poster from the
@CUH_NHS
- we will never
#Lego
of awesome
@Courtney_Comms
😉👏👏💫
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Hope everyone has had a Fabulous Day of Older People!
So much more to do, in promotion of healthy ageing, prevention and reversal of early frailty, management of single and multi-morbidity, person centred non- ageist frailty attuned care.
@GeriSoc
@Dochayter
@jupiterhouse1
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Dr Henry Woodford, BGS Newsletter: "Is it really causing any harm just to ‘be sure’ we haven’t missed a UTI? The answer is overwhelmingly, yes! ...your diagnosis is wrong, real reason for the person being unwell goes unknown and untreated"
@marktaylor18
@GeriSoc
#dontbeadipstick
@GeriSoc
@sean9n
@mancunianmedic
And here is the effect for all of us if we don’t stop unnecessary use of antibiotics in Asymptomatic Bacteruria. The most common sepsis causing organism (E coli) is rapidly becoming multi-resistant
#dontbeadipstick
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Happy
#InternationalWomensDay
to some fabulous women fighting for improvements in health and care for older people
@jupiterhouse1
@EstherClift
@JennyKeaneNHS
@Car_Abrahams
@SarahMistryBGS
@JKDhesi
@ali_cracknell
@Annawinf
@AnneIFICScot
and too many others to mention
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How can the mantras of better community care, care closer to home be delivered without district nurses? I'm genuinely curious about the rationale
@theRCN
@CrystalOldman
@michelledrage
@Jeremy_Hunt
@uk_chancellor
@theresa_may
Funding cuts by
@NHS_HealthEdEng
mean that training for the critical role of the District Nurse is being cut completely and 50% of DN training programmes in universities face closure in 2018 if there is no action. Look out for
@TheQNI
position statement on the risk to the system.
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Delighted to see publication of Guidance on the design and delivery of Proactive Care.
This adds to the suite of community based services focussed on the needs of older people, especially those living with frailty.
Alongside Urgent Community Response,
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And not just young woman! A woman at any age with urinary incontinence deserves a proper assessment. Almost always treatable to some extent.
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Keep reminding them as admission diagnosis"acopia" has higher mortality rate than sepsis
@RyanMasonBHSc
Someone wrote "acopia" in the notes of a patient with complex parkinsons, frailty and falls. Time to re-educate......
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Of course I would not suggest PA's replace doctors. However I am putting myself in the shoes of the CD in a DGH with gaps on the endoscopy rota.
Missed cancer cases?
Let's put the blame where lies - those who have starved our NHS of staff and funds.
@EileenBurns13
If the government are blocking doctors, why would you promote filling gaps with non-doctors?
Is your profession not worth protecting enough that you would rather be complacent in this? Or would you rather promote a gold standard of care and fight for what patients deserve?
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It's called continuity of care and it's in danger of becoming one of those things we remember fondly like the firm. But it's really important for people and reduces health care demand.
@elinlowri
@GeriSoc
I am struck, after today’s clinic, how much easier it is to make difficult, risk-sharing, uncertain decisions with people you have known for a while, and who have got to know you. Mutual trust and respect doesn’t appear overnight!
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What a team, what a lady!
On J15 today
@LeedsHospitals
we were delighted to discharge Gladys who is 101 years old and has recovered from Covid 19 - a fantastic moment for the team to celebrate! 👍🏻🥳❤️😊🌈🎉🎈🎊
@gillianmfox
@LTHTPhysio
@BevBrow29307420
@yvetteoade1
@philwoodLTHT
@LisaChiefNurse
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Do we need an army of volunteers who can proactively ring relatives once day to update them on the patients for whom there's no clinical urgency to communicate? Would reduce ward staff demands, may give them more time to speak with those families who need a clinical update?
It’s increasingly hitting me that no visitors is one of the hardest things about this pandemic forpeople in hospital. Fear enhanced for all. How are you adapting to keep families connected at their most important times, and support staff who have to share bad news over the phone.
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Some beautiful photography at
#NHS75
celebration at Westminster Abbey including this by an
@LeedsHospitals
research nurse Ewa Gasior "We've Got You". Had to grab a pic with the artist herself!
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But please remain very careful, protection less after a single dose. One of my consultant colleagues, vaccinated more than a month ago has proven Covid. Don't let complacency slip in! And let's ensure everyone at risk gets their second dose asap.
Am seeing cases now of vaccinated patients not catching covid at all when exposed at home - or much milder illness
Dramatic local outbreak in local care home where those vaccinated were spared
This is 1st hand / coal face experience
#VaccinesSaveLives
🙏🏻
#CovidVaccine
💉💉
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Excellent day
@RCPLondon
@GeriSoc
. Takeaway messages: identity frailty and specify it as a diagnosis
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Read about pain assessment in older people- published in
@Age_and_Ageing
- BPS/BGS joint work.
@GeriSoc
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@davidceh08
@RCPLondon
@GeriSoc
Acute Frailty unit can have major positive impact on patient flows. Location less important than function
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Completely agree. We need nuanced guidance not blanket single issue NICE guidance. Our patients need non-ageist, frailty attuned care. If I'm 94 but fit and active get me straight down for my scan. If I'm 79 and severely frail, not fit for any neurosurg intervention don't do it.
New NICE HI guidelines: deep inside the rationale section is some helpful expansion on the new "consider" CT for px on anticoagulants or anti-plts.
Is this enough to stop the pantomine of shipping care home & community hospital px to ED for a CT? They're in monitored settings...
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The evergreen
@betterageing
did a great job positively dancing onto the stage to present the award for improving patient safety for older people. Excellent work Amit!
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So basically, better to start earlier but never too late to start! (Says she smugly, having just completed the
@Couch25K
(to be clear, 5K...just on case anyone thought I meant 25K) !
Exercise in Octogenarians: How Much Is Too Little?
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For older people living with frailty, fair to say evidence for effectiveness of Hospital
@Home
services ( "hands on" treatment from an MDT) is very persuasive (mortality, res admission, pt satisfaction). Less evidence for Virtual Wards, defined as remote assessment and treatment
Fair to say the jury is still out on this: leadership, clinical governance and a keen eye on objectives and outcomes are key..
Virtual wards: a rapid evidence synthesis and implications for the care of older people | Age and Ageing | Oxford Academic
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Important messages about how to reduce your risk of ill health in old age, and (hopefully) impetus to us all to start to plan for ourselves, our community, nationally, internationally...
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Big publication from some of our specialty's top academics- important work
@GERED_DOC
@GeriSoc
in the Lancet again. Identification of frailty using routinely collected hospital data: Hospital Frailty scale. First cousin of the eFI?
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1.
@geri_baby
& I spent some time& energy a yr or two ago trying to convince
@NHS_HealthEdEng
ltft working (aka flexible)is part of workforce crisis solution if you plan and recruit for it. After 35 yes FT I have renewed love of life in and out of work 3days/week.
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Urine is smelly. If you have an episode of urinary incontinence (for any reason) there will be a smell of smelly urine. It's absolutely not a diagnostic test.
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@ChrisCEOHopson
Can't DM you Chris. It seems from your thread you anticipate older people marooned in hospital will be main occupants of these beds? If ASC & com health can't support discharge & acute hospital staff are already over stretched, who do you envisage will care for these patients?
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Roundhay park looking spookily ethereal this morning. Week 5
#Couchto5k
...started in May...
#lifeafterpresidency
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2. Don't insult them. Clap them if you like. Pay them well with proper terms and conditions. Provide them and their residents with integrated support. And for goodness sake, plan now for the next wave and do it properly.
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@campbellclaret
@GraceCampbell
A young man dropped a plastic bottle out of a car window as I was walking down the adjacent pavement. Traffic light on red so he had to stop. I picked up the bottle, tapped on his window and handed it back "I think you dropped this". He took it and off they went. :)
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#GarethSouthgateWould
phone the family for collateral history as soon as it was daylight
@toates_19
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Is hydroxyzine the most prescribed drug in care homes? We need a campaign to stop automatic prescription of anticholinergics for itch ... diagnosis of the cause and appropriate treatment, whether emollients or other less harmful.
The Anticholinergic Risk Scale. Review if older persons are on anticholinergic drugs and stop them if you can
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Spoiler alert: improving psychological and cognitive status, improved psychotropic prescribing, orthostatic hypotension and mobility likely to reduce the risk of progressing from having a single fall to being a "faller". Great work
@tilda_tcd
!
Eight-year longitudinal falls trajectories and associations with modifiable risk factors: evidence from The Irish Longitudinal Study on Ageing (TILDA)
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Storming Trevor Howell lecture by
@finbarr45452612
referencing
@MichaelMarmot
- health inequality a political choice. Better life expectancy only for the relatively affluent. Life expectancy of deprived has failed in improve. What kind of a society do we want?
@GeriSoc
#bgsconf
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Ok, so
#RCPEGM
London Weds was a car crash
But ACPs do endoscopies and they're not utilising additional skills they bring from nursing care.
American studies say PA endoscopists have similar outcomes (ADRs/ completeness/ effectiveness).
What do PA's bring to the MDT?! Capacity!
Would you board a plane without a qualified pilot? Would
@BALPApilots
stand by? Nor will
@TheBMA
. Cannot replace training, experience & expertise. Human body not uniform & often unfit for purpose. It’s not always routine & easy but goes wrong often - both planes & patients crash.
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Brilliant news- massive congratulations, Jackie! Go lady Geriatricians everywhere!
@JackieDocjt
@RCPSG
@GeriSoc
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Delighted to be at the "official" opening of The Cabin
@stgemmashospice
- a facility for young people who have been bereaved. Amazing work by the fundraisers and designers. In the beautiful hospice gardens, it feels nothing like a clinical facility (in a good way, obviously)!
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Despite no RCTs evidence proactive care in care homes right thing to do seems undeniable Transforming health care in nursing homes Evaluation dedicated primary care service in outer east London. CCGs/ STPs take note!
@runnermandoc
@GeriSoc
@adamgordon1978
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