Areas of Expertise
General Medicine and Acute Admissions
General Medicine is concerned with treating and diagnosing many diseases affecting the body where primary treatment does not involve surgery.  A general physician (a doctor specialising in general medicine) usually treats all medical conditions either chronic or acture and may include cardiovascular, gastrointestinal, neurological, respiratory, haematological or endocrinological.  General Physicians usually have a particular area of interest in a specific aspect of General Medicine and become an expert on these conditions.  General Physicians can organise a broad range of diagnostic tests and will co-ordinate the patients on-going investigations and management of care.

Sometimes, patients may suffer from an acute episode of their medical condition which may require admission to a hospital or special unit called an AMU (Acute Medical Unit) where they will be assessed, treated and then either discharged or transferred to another ward or unit for on- going specialist care and treatment.

Dr Roche specialises in Acute Medicine and is part of the Acute Admissions Team within The Clementine Churchill Hospital, Harrow, The Wellington Hospital, St John’s Wood and The St John and St Elizabeth Hospital, St John’s Wood.

Medicine for the Elderly
Medicine for the Elderly is concerned with the optimisation, care and welling being of older patients and covers several organ systems rather than distinct disease diagnosis.

There are certain complications or conditions which more commonly affect older patients which can be defined by broad categories which impact on physical, mental and social aspects of older adult's life.  Many of these conditions, however, can be improved.  These conditions include:

  • Incontinence
  • Postural instability and falls
  • Dizziness
  • Frailty
  • Dementia
  • Delirium
  • Depression

Dementia
Deterioration of intellectual faculties, such as memory, concentration, and judgment, resulting from an organic disease or a disorder of the brain. It is sometimes accompanied by emotional disturbance and personality changes.
http://www.dementiauk.org/
http://www.brt.org.uk/home
http://www.atdementia.org.uk/

Delirium
A sudden state of severe confusion and rapid changes in brain function, sometimes associated with hallucinations and hyper or hypo activity.

Frailty
A condition, seen particularly in older patients, characterized by low functional reserve, easy tiring, decrease of libido, mood disturbance, accelerated osteoporosis, decreased muscle strength, and high susceptibility to disease

Parkinson’s
A slowly progressive neurologic disease that is characterized by a fixed inexpressive face, tremor at rest, slowing of voluntary movements, gait with short accelerating steps, peculiar posture and muscle weakness (caused by degeneration of an area of the brain called the basal ganglia), and low production of the neurotransmitter dopamine
http://www.parkinsons.org.uk/
http://www.cureparkinsons.org.uk/
http://www.parkinsonsmovement.com/

Alzheimer’s
Alzheimer's is the term used to describe a dementing disorder marked by certain brain changes, regardless of the age of onset. Dementia is a condition resulting in significant loss of intellectual abilities such as memory capacity, severe enough to interfere with social or occupational functioning. Alzheimer's disease is not a normal part of aging. It is a neuro-degenerative type disease due to the abnormal accumulation of a protein called Beta amyloid. It is one of the dementing disorders, a group of brain diseases that lead to the loss of mental and physical functions.
http://www.alzheimersresearchuk.org/home/
http://alzheimers.org.uk/  
http://www.atdementia.org.uk/

Depression
Depression can be caused by various factors in older people including retirement, bereavement and increased isolation for example.  The symptoms of depression can affect every aspect of life from energy, sleep, appetite work and relationships.  Some medical conditions can trigger depression in the elderly and some prescription medications may also have the side effect of causing depression including drugs to treat Parkinson’s Disease,  dementia, cancer, heart disease and diabetes.
Overcoming depression in the elderly is not easy or quick but with the right support, guidance and professional help, it is not impossible.
 http://www.ageuk.org.uk/health-wellbeing/conditions-illnesses/

Incontinence
Incontinence is defined as the inability to control either urine or faecal elimination and an individual may excrete urine or bowel movements when they do not want to.  People of all ages can suffer but the majority of those affected are women.  The elderly are commonly affected because of weakend pelvic muscles, urinary tract infections, diabetes or the inability to move quickly to get to the toilet in time. http://www.ageuk.org.uk/
health-wellbeing/conditions-illnesses/incontinence/?gclid=CKG7x-GuirICFYKMfAodnjEA_g

Patients suffering from dementia may also be affected and caused by additional problems due to confusion and distress.

Postural Instability
Postural instability is a loss of balance which causes someone to feel unsteady.  Many older patients who have Parkinson’s Disease may begin to have problems with postural instability due to the loss of postural reflexes.  It is one of the most common causes of fallls in people with Parkinson’s Disease and can result in head injuries and fractures so should always be treated seriously.
http://www.ageuk.org.uk/?gclid=COrPxZSvirICFcYMfAodw0EA3Q

Dizziness
Dizziness in older people is very common, often persistent and can be very incapacitating.  This condition may have many and varying causes and sufferers may complain of feeling faint or lightheaded with a loss of balance.  It can usually be related to a number of factors and age related changes on the body.  Patients will need extra physical support and as well as the physical effects, it can affect those suffering both socially and emotionally.  Treatment is possible and will need to be discussed with the doctor to find the underlying cause and further investigation and tests if required.
http://www.brainandspine.org.uk/information/neurological_conditions/dizziness_and_balance_
problems/index.html

Restless Leg Syndrome
Restless leg syndrome (RLS) was first described by Ekbom in 1945. It characteristically affects the legs but can occasionally involve the arms. There is an urge to move with associated burning, tingling, aching, fidgeting, throbbing, tightness and occasionally a feeling of insects crawling under your skin. Pain may be a predominant feature. Symptoms tend to be worse in the evening or at night. It affects all age groups but increases with age.

RLS is a common cause of insomnia, unrefreshing sleep and excessive day time sleepiness. It has a higher occurrence in Women.

General Elderly Care Sites:
http://www.ageuk.org.uk/
http://www.rice.org.uk/

© Shane Roche, 2012 Site by Wizbit and Medici Marketing