Vicky Ewan (Mentor)
Hello, I'm a registrar (doctor) in medicine, specialising in older people, and I do research into infections which affect older people. I've also worked in the Newcastle Falls clinic.
Location North East
Activity
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Hi Janet,
You could have a look at the falls directory - there's a link to it via age uk at the bottom of the page- just type in your postcode. -
Vicky Ewan (Mentor) replied to Ruth Hall
Hi Diane,
it very much depends what your normal blood pressure is- for some people 90 systolic is normal- often people who are quite fit. For others if their systolic is 160 normally then a drop to 120 might even be significant. -
Thanks Kamalakant- that's a great story! Fantastic that you're so much better and very interesting to hear how you improved.
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Dear Ted,
research trials definitely do not sell your data. NHS records in general may be a different matter (I don't know much about it actually) but research personnel who access your medical records use the data only for research purposes. There are now extensive sections on data handling when applying to start a research trial and gain ethical... -
Hi Pauline, I've added a link below to some more falls prevention resources- click on the falls directory to see where classes might be near to you.
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Vicky Ewan (Mentor) replied to Su Hua LEOW
Hi Su Hua,
wondered if this quick video on Epleys's manoeuvres might help at all? -
I've found a few but they're not exactly the same- will feed back to the team and see if anyone has a particular recommendation.
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Vicky Ewan (Mentor) made a comment
I like the inflatable underwear idea! Personalised airbags!
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Hi Graeme,
hip fracture is a major life event- but some people do recover and go back to their 'old' lives. I did a study on people who had fractured their hips and I used to phone them three months after discharge. Some were still recovering, but others were going on as normal. -
That's a good idea Gwen.
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That's research for you! It's very very tightly regulated now.
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Well done Lorna for mastering the stairs!
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Vicky Ewan (Mentor) made a comment
Great to hear all the improvements you've made :-)
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You couldn't determine exactly what the underlying diagnosis was from a prescription of stemetil- but usually given for vertigo in general.
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Yes- drinking litres and litres of water can be dangerous. 1.5-2 litres is generally safe (unless severe heart failure where less would be needed).
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Yes that's it- the information helps you think about what has happened to you- a context for your symptoms.
But self-diagnosis is generally best avoided. Not that you're not necessarily right, but that it's almost impossible to be objective.
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Vicky Ewan (Mentor) replied to Tom Reeves
Yes- without the pacemaker, the electricity sometimes doesn't get through from the atria to the ventricles which to the pumping. So there is a long gap from one heart beat to the next and that can cause you to fall or black out. The pacemaker detects if there is a pause and gives the ventricles a quick 'zap' to make them pump. (if that makes sense!)
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Under 60.
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Sometimes people with high blood pressure can also have low blood pressure too ( at different times of the day. You can detect this with an ambulatory blood pressure monitor (GP can arrange this if you're often feeling light headed). Sometimes people can have white coat syndrome where their blood pressure is high in the clinic so they are prescribed...
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Vicky Ewan (Mentor) replied to Ruth Hall
Hi Ruth,
if you're not falling, and not feeling dizzy and BP is low/normal then you probably don't need to worry either.In general if you want to get a sense of your blood pressure readings then you can often borrow a machine from the GP. You take it twice every day, a few minutes apart for 7 days and then average the reading for each day. This is...
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I like your vasovagal triad Peter!
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Those are really good practical suggestions Anthony. I really like the salt gritting container!
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Yes and 'drink water' doesn't sound very exciting- but it can work in some cases. People with bad heart failure should discuss with their doctor/specialist nurse before drinking a lot of water though.
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James made a comment about this earlier- tot he effect that there haven't been any large trials but that common sense would suggest it might help.
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Thanks Andy and Emma!
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I totally agree Brenda- I always make myself put mine on when I'm up in the night, and you're right it does sort of wake you up a bit too.
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Vicky Ewan (Mentor) replied to John Gray
I think it must be badly reported too. On the face of it, it sounds like a money saving exercise, but given that the article has got the evidence wrong- maybe they've also just got the wrong end of the stick? Totally agree they should have included the evidence to go with that statement- but it's always hard to judge articles such as this. Perhaps they are...
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Hi Laura, I don't know much about yoga but maybe you were just tired..! Try doing the Epworth Sleepiness scale..
http://www.britishsnoring.co.uk/sleep_apnoea/epworth_sleepiness_scale.php
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Great idea! Definitely room for a sitcom on the TV... especially one that deals positively with age...!
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Vicky Ewan (Mentor) made a comment
Hi folks,
this is a link to the study information page, and the protocol can be downloaded at the bottom of the webpage (the protocol is a summary of what is actually done in the study).
http://www.nets.nihr.ac.uk/projects/hta/097004And here is the link again to a page which details a little more about...
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Yes. Also happens a lot on aeroplanes. People seated for a long time, go to the toilet and then collapse because of low blood pressure.
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Hi Koula, I think if you feel light headed as if you're about to faint then drinking water, not wine would be helpful. The evidence about salt is a bit more mixed. But sitting or even lying down and having a large glass or water is much better than fainting. Lying down with your legs in the air is the best position because all the blood in your legs is...
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Sorry about that Anastasia- if you click the feedback tab to the left of the screen you could let futurelearn know and I'll email the technical people as well.
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That's interesting Kamalakant- how did you feel after you stopped taking it? Less drowsy? Or less unsteady?
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Thank you Christina, I've learnt something there- hadn't heard it referred to in that way before. We ought to do metaanlaysis routinely during a hospital admission as well - I suspect it varies by the provision of ward pharmacists.
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She was discovered when someone noticed she hadn't opened her curtains - and broke in to get to her. I can't quite remember exactly how she fell now.
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Good luck with that :-)
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Not sure of the specifics but here is a page that might be useful- doesn't include information on exactly what they do.
Gap seems to be a possibility- has a geriatrics specialty.
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Hi Donald, here's a link to a falls services directory. Stick your postcode in and see what's in your area.
http://fallsdirectory.com/search-results-falls-prevention-services-in-your-area/
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Vicky Ewan (Mentor) replied to Tom Reeves
They do look a bit like that!
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Vicky Ewan (Mentor) made a comment
Here are a few links:
Nice pathway on who and how people should be assessed for osteoporosis. Click on the boxes in the pathway to get more detail at the...
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Hi Dominque,
this is a good one- though doesn't talk about calcium I don't think- very comprehensive.http://www.cdc.gov/nutritionreport/pdf/Nutrition_Book_complete508_final.pdf
Here is a good one on calcium
http://www.uptodate.com/contents/calcium-and-vitamin-d-for-bone-health-beyond-the-basics
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Excellent!
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Yes it can recur- the exercises can help again in the future though because it's still the same problem.
Here is ia link to a study on how common it is- yes it is common (2.4% lifetime incidence)
http://www.uptodate.com/contents/benign-paroxysmal-positional-vertigo/abstract/4?utdPopup=true -
Vicky Ewan (Mentor) replied to Janet Bird
Hi Janet, you can check the location of falls services near you using the falls directory- have posted a link to it below.
http://www.ageuk.org.uk/health-wellbeing/doctors-hospitals/finding-your-local-falls-services/
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From a medical perspective, the 'what then' is that you make a capacity assessment for that particular decision- can the person take in, believe, understand, weigh and retain the information long enough to make a decision. If they can, then whatever decision they make, even if unwise in your eyes, is theirs to make. If they don't have capacity for that...
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Hi Raymond, we have a saying for starting older people on medications- start low, go slow.... yes, breaking them in gently can definitely help. Different preparations can sometimes make a difference as well.
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That's a great approach Astrid.
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Hi Angela,
being a carer is an enormous strain, and the real value that people are providing, often without pay is immense. It might be worth booking an appointment with your GP specifically for a medication review once a year in order to have the right sort of time on it. GP computer systems often have useful medication alerts as well which can flag up... -
Hi Christina, do you mean medication analysis? Metanalysis I take to mean something different..
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Vicky Ewan (Mentor) replied to Patricia Thomas
ooh.. we probably don't use the phrase "bed-blockers"... I know what you mean- " unecessary increased length of stay" might cover it... not as snappy I know.
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Vicky Ewan (Mentor) replied to Rachelle Hughes
Hi Rachelle,
yes this is a slip due to environmental hazards so you aren't in the group who are likely to have recurrent falls. I think just general advice applicable to people of any age about making the environment safe (not leaving things out on the floor, on stairs etc) would be useful to you. -
Vicky Ewan (Mentor) replied to Lindsay Perks
That sounds rotten Lindsay- hope you take away some tips reduce your risk of falling.
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Vicky Ewan (Mentor) replied to Barbara Smyth
In the UK, they're usually within hospitals...
Here is a link the an age uk webpage with a falls directory within it- you enter your postcode and it gives falls prevention services.
http://www.ageuk.org.uk/health-wellbeing/doctors-hospitals/finding-your-local-falls-services/
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Vicky Ewan (Mentor) replied to Debra Snyder
Thank heavens for nurse practitioners! They are a good bunch.
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Thanks for that Tony- very useful information.
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Hi Ravi,
do you have a mobile phone at all? Could that help? Or if not any neighbours nearby? -
That's another really good idea Helen- thank you. Do you have a link to the type of phone it was that can do that?
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What a great idea- do you have a link to where people can get hold of these Mary?
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Hi Joan,
I used to have a mobile phone pouch which I clipped on the my clothing with a carabena- that way I could get to it easily and it couldn't fall out. Don't use it now as my new bigger phone won't fit... -
I once treated a patient on medical admissions who had fallen in the bath and couldn't get out- and had been there for three days.. she was in fantastic condition considering, because she had run the warm water to keep warm and drunk the cold water from the tap to stay hydrated. Quite amazingly she was relatively well considering the ordeal she'd been through...
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I think keeping a mobile phone on you is a good idea- and maybe just taking a moment to assess yourself (am I confused, did I black out, can I wiggle all my toes etc etc) and the environment and then think through what your options are in that given situation.
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Hi Jacqueline,
found this from age concern- but not any more useful really..http://www.ageuk.org.uk/health-wellbeing/keeping-fit/falls-prevention/exercise-regularly/
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Well done for keeping active and keeping going after that scary experience. 30 minutes twice a day is very impressive!
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Vicky Ewan (Mentor) replied to Robin Barnatt
Yes, psychiatry is one area where stopping medications can be genuinely risky in some patients. But equally necessary in others.
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Vicky Ewan (Mentor) replied to Deborah Belanger
Hi Deboarah, you need a 'generalist'- someone like a GP or a hospital generalist (not sure which country you're in) who can look at you as a whole and help decide, in partnership with you, if there are any that can be stopped.
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Vicky Ewan (Mentor) replied to Jean Smith
Hi Jean,
yes it's a tricky balance- we can't always stop certain medications even if we want to. I think the aim is to reduce as far as is possible for that particular person. The more health problems someone has, the harder it is. -
I've just worked out it's not actually a video- just a picture which looks like a video...
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Hi Edith,
this is a link to a useful webpage- hope you find it helpfulhttp://www.rcpsych.ac.uk/mentalhealthinformation/therapies/cognitivebehaviouraltherapy.aspx
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Hi Tim,
the trial hasn't yet finished so the results aren't yet published. I think it finishes early next year. CBT is not a 'quick fix' and may take years for people with serious mental illness though the benefits may start early on. Having said that, in some people, with certain problems, even four sessions can make a huge difference. It just depends... -
Hi Sylvia,
the picture on the right shows osteoporosis- the 'bone' is less dense so overall the picture appears darker. The bony bits are the pale brown colour, and it should look like a nice thick mesh. In between the bony mesh (in the spaces on the picture) is bone marrow- thick blood which is where all our blood cells are 'born'. You can't see the... -
Vicky Ewan (Mentor) replied to penny rosenthal
No- we just haven't caught up yet with our new ageing population. It's only been about ten years that we've had this larger over 85s group. It will just take a little time for us to start reducing disability as well as mortality. But we'll get there.
No falling off cliffs (though my mother shares this sentiment)- preventative medicine is the key. So...
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If you're talking about falls then yes the fear might be about the consequence. But other fears and phobias may be linked to another situation which sometimes may be less obvious. CBT helps you untangle the automatic thoughts you may not be aware of occurring, and to address them.
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Firstly, I would say that I still feel very lucky to have a "free" health service. Nobody asks you for your insurance before they give you have painkillers for your broken leg. Second, if you're really sick, the service is, in my opinion and in the places where I've worked, pretty flipping good. Continuity however is an issue (imo)- and makes it much less...
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Yes- it's very hard to care for your own relatives- and usually best avoided if at all possible. You either ignore all their symptoms when you shouldn't or treat every little thing. It's very hard to find the middle ground.
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Made me chuckle though!
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Vicky Ewan (Mentor) replied to Debra Snyder
Debra, having seen some of your other posts, bppv may be less relevant to you if demyelination is an issue - bppv normally lasts a very short time, not for hours. Apologies- I should have mentioned that in the earlier post.
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Yes- it's such a common problem. Hopefully relatively easy to fix though.
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Great Elaine! That's a good way of putting it. Maybe bells for the bunnies?!
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Glad you're finding it helpful Cristina.
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Vicky Ewan (Mentor) replied to Nancy Butler
What a clever idea Nancy.
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Vicky Ewan (Mentor) replied to Pauline Campbell
Yes it's amazing that water can help!
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That must be hard to have to manage on a daily basis Debra. Hope you manage to take something away from the course that makes it a little easier for you.
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Hi Linda, sorry to hear that- and hope having your cataracts sorted will help.
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Well done for getting it checked Anne.
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Sorry to hear that Christopher. Hope you are recovering.
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Vicky Ewan (Mentor) replied to Debra Snyder
Hi Debra,
have a look at the section on BPPV- benign paroxysmal positional vertigo. That may well be what you're describing- and it can be treated in many people with a series of head movements called Epley's manouevres. Have a chat with your GP. -
Michael, you're right- it is harder to balance and walk as we age- but that doesn't mean that falls are inevitable with age.
The idea of the course is to teach people what we already know to minimise the risk of falling and its consequences.
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Hi Valerie, Welcome, and hope you find it easy to catch up- there's no rush, just do it at the pace that suits.
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Did you mean ground?!
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Vicky Ewan (Mentor) replied to penny rosenthal
Penny! The idea is that you don't fall over! Sensible doesn't have to mean unflattering...
Although admittedly when I offered my grandma a pair of my very comfortable work shoes she did say something like "over my dead body, I'm not wearing those..." (They were a tad unflattering if I'm honest...). There's a bit more choice though now...!
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Vicky Ewan (Mentor) replied to dave webber
Long may it continue!
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Good philosophy Blanka!
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Yes glasses can be very expensive. There are some cheaper options available but yes changing glasses at work would be tricky. I think Liz had talked about having a distance pair just for outside and keeping the vari/bifocals for work/inside. But it does depend on the cost.
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Hi Pauline, maybe think about changing one thing, perhaps whatever you perceive to be the biggest risk. I didn't quite understand what you meant about removing hazards making you reluctant to leave home. Great that you're practising a better gait and exercising!
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Hi Meteor, really glad the course is helping you to look after your grandparents. Regarding the diabetes medication it might be worth a review by a health professional who knows her and can assess how her diabetes is doing. Diabetic medication is important and shouldn't be just stopped without proper advice.
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Great Pauline- glad you're thinking about removing some of those hazards.
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Well done Monica!
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Great idea Catherine. Walking is one of the best forms of exercise.
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Dear Peter,
if tripping on trousers legs is a problem there are some shorter versions available now, and ones with elastic at the bottom (more legging like)... maybe a Christmas present?!
