Kenneth Rockwood

Newfoundlander. Geriatrician, internist. Big on sharing Comprehensive Geriatric Assessment, individualization, and the joy of geriatrics to enable frailty care.

[Kenneth Rockwood @Krockdoc]

We’ve all seen renaming mistaken for progress. Who wouldn’t say they hate the name cancer too, especially if primed with this:
“a practice or phenomenon perceived to be evil or destructive and hard to contain or eradicate”? Progress requires us to focus on the condition.

[Giuseppe Bellelli @GiusepeBellelli]

I couldn't agree more with this @Krockdoc

[Kenneth Rockwood @Krockdoc]

Yes! And the benefit from grades of frailty. Also favours treatment trials, with patient-centred goals, and special attention to the early treatment response. See: “Frailty affects the initial treatment response/time to recovery admitted to hospital…” Age Ageing. PMID: 28104595.

[Victoria Ramos @vicktoriavic]

Frailty in older adults @Krockdoc 👏👏👏👏👏

"Frailty assessment should be used not as a convenient way to withhold potentially effective treatments but rather as a tool to facilitate patient-centered care"

#Frailty #MustRead

[Kenneth Rockwood @Krockdoc]

Good on ya. In my experience, it’s not the word to which people object, it’s the state. Better than renaming, understand frailty and tackle it. Often in hospitals, no matter the word, many are comfortable in denigrating the people who live with it. That’s what needs to change.

[Karen @Karen17997643]

@DrAROrkaby @DaeKimMD @Krockdoc @NEJM I am going to try to read this with an open mind.. the word "frailty " just makes me uncomfortable.

[Kenneth Rockwood @Krockdoc]

Good luck with the pitch

[Geriatrie Altersmedizin Ulm @IfGF_UUlm]

@Krockdoc @DaeKimMD Excellent & important review that we used for a pitch for a potential German frailty network right on the day it appeared 😀 whatta timing 🎉 #frailty @NEJM @AgeingRes

[Kenneth Rockwood @Krockdoc]

Many thanks to @DaeKimMD for his energy and infinite patience with this.

[Sandra Shi @shisadoctor]

YAAAAAAYYYYYYY

Frailty in Older Adults | New England Journal of Medicine https://t.co/8uKvVl1pFo

[Kenneth Rockwood @Krockdoc]

Changing practice is an uphill climb. An amazing privilege in my current job (one of them, with Nova Scotia’s Frailty & Elder Care Network) is helping to shape policy. We’ve started with a mobilization strategy. Collecting data still, but the clinical impressions are encouraging.

[Kenneth Rockwood @Krockdoc]

Clinical response to a ChEI Stanley J, et al., The Clinician's Interview-Based Impression of Change (Plus caregiver input) and goal attainment in two dementia drug trials: Clinical meaningfulness and the initial treatment response. Alzheimers Dement. 2021 May;17(5):856-865.

[Kenneth Rockwood @Krockdoc]

Works the other way too. Early recovery portends a better prognosis. Holds for bed mobility with hospitalisation
Hatheway OL, et al., Frailty affects the initial treatment response and time to recovery of mobility in acutely ill older adults... Age Ageing. 2017;46:920-5 and in/

[LeedsFrailtyEducation @LeedsFrailtyEd]

The longer someone is unwell for, without improvement, and the more illnesses they develop, the lower their chances of recovery. Remember frailty is about deficit accumulation as much as phenotype. Accumulating lots of deficits in a short period is a bad sign

[Kenneth Rockwood @Krockdoc]

The signal is in the instability. Deficits accumulate when damage goes unremoved/unrepaired. In a sufficiently safe environment there is time for recovery to work when repair times are not prolonged. Unsafe environments challenge by a higher damage rate and longer repair times.

[Global Frailty Network @GlobalFrailty]

Excited to announce the release of the book, "Frailty: A Multidisciplinary Approach to Assessment, Management, and Prevention"! Dive into a comprehensive exploration of managing frailty with insights from various fields. https://t.co/hj2WxAEYli

[Kenneth Rockwood @Krockdoc]

Well done @NebPublicMedia “The paintings [of patients and care providers] serve another purpose, to soften the medical gaze.” Beautifully encapsulates what is so compelling about your work and why it should have wide exposure. A valuable 8 minutes for us all. Congratulations.

[Kenneth Rockwood @Krockdoc]

I was honoured to have been part of it. This has the makings of one of those few PhD theses that can change practice: an RCT of frailty screening + CGA in Emergency. @GERED_DOC @dhj_davis @SearleDoc @KarenNi94040245 @geri_EM

[ARC: Ageing Research Centre University of Limerick @ARC_UL]

Huge congratulations 🎊 to our wonderful colleague Dr Aoife Leahy on her successful PhD viva defence today.

Aoife was examined by @McCreesh_Karen & the foremost International expert on frailty @Krockdoc 🇨🇦

📸 with supervisors @galvin_rose and Prof Mgt O'connor @ULHospitals

[Kenneth Rockwood @Krockdoc]

It remains a valuable resource, which is a little sad. It’s so old that @tdbrothers who played the beleaguered resident, was then a med school applicant. Now he’s TD Brothers MD PhD FRCPC - a passionate internist and Addictions Medicine specialist. Please God, let Dal hire him.

[Phil Noyes #FairPayForNursing @ShirtyPhil]

@dr_shibley @Krockdoc Thanks for sharing - had ringside seat for this recently and your prior posting equipped me to recognise this

[Kenneth Rockwood @Krockdoc]

@LeedsFrailtyEd Great, Sean. Thanks. At-a-glance pattern recognition of brief tests done well lets us help others to see what we see. For the many countries that had a baby boom, what we see in hospitals now reflects that in 2021, the leading edge of the boomer wave began to turn 75. Buckle up!

[Kenneth Rockwood @Krockdoc]

Only back here to complain about an academic thing. Journal Editors: I just spent hours reviewing a paper. Tried to log in: why require my username and password? What stops you from offering one option for logging in directly? Wouldn't that optimize for receiving reviews on time?

[Kenneth Rockwood @Krockdoc]

@dr_shibley @David_D_Ward Like many geriatricians, I’m a wary optimist. I see it pregnant with prevention. And a way to approach the many pathological features. My bet: hallmarks of aberrant repair. This permits understanding the diversity of pathologies: with age, more damage goes unrepaired/unremoved.

[Kenneth Rockwood @Krockdoc]

I’m sorry for that. The CFS began using judgment to integrate items in a Comprehensive Geriatric Assessment. Health deficits accumulate to impair high-order function: in mobility, daily activities, +/- cognition. That’s ≠ impairment from single-system disorders in young people.

[Elisabeth Benn @benn_elisbenn]

@Krockdoc I was classed as frail simply for using a self propelled wheelchair for c30 years. CFS has limitations especially the e version.

[Kenneth Rockwood @Krockdoc]

Congratulations Ilaria. As you know, that award has an impressive pedigree. To which your name adds further lustre.

[Kenneth Rockwood @Krockdoc]

Congratulations on this. I know that it’s been a mountain of work. It’s an important topic for the field, and very nicely handled.

[Susan Howlett @SusanEHowlett]

Our new review in @Cell_Metabolism on the relationship between Metabolism and Frailty is now live! Discusses how maintaining a youthful metabolism in later life can help prevent frailty. Congrats to co-authors including @Alice_E_Kane @mmishrabio
https://t.co/dRU9LkKfFG

[Kenneth Rockwood @Krockdoc]

Well done. Delirium as a preventable cause of dementia deserves study. Much of it arises unrecognized from unnecessarily hazardous routine care of older patients who live with frailty. Polypharmacy, untreated pain, immobilization, and chronic indifference all take a costly toll.