We Care – A Socio Initiative by SGI

Comprehensive geriatric assessment of older frail people.

The essence of geriatric medicine is to assess and treat the medical and rehabilitative needs of older people. The key expertise of the specialty in assessing the clinical needs of the patients is the comprehensive geriatric assessment. This is recognized as a multidimensional interdisciplinary diagnostic process focused on determining a frail older person’s medical, psychological and functional capability in order to develop a co-ordinate and integrated plan for treatment and long term follow up.

  • Rehabilitation of Older People
  • Acute Medical Care for Older People
  • Collaboration between Geriatricians and Psychiatrists of Old Age
  • Comprehensive assessment for the older frail patient in hospital
    Intermediate care
  • The specialist health needs of older people outside an acute hospital setting
  • Geriatric (Medical) Day Care Hospitals for older people
  • Assessment of Older People for Continuing Care
  • Palliative care
  • Geriatricians and management of long term conditions
  • Abuse of Older People
  • Hospital Discharge of Older People with Cognitive Impairment to Care Homes Falls
  • Continence Services
  • Stroke
  • Orthogeriatrics

Introduction

Older people are important and valuable members of society who are entitled to effective and efficient health services to promote health and minimization of disability in late life. The principles of good medical and social care for older people are:

  • Involvement of older people in the management choices of their illness and decisions on future care;
  • To promote good health in late life;
  • The prevention of illness;
  • Reduction of disability;
  • To support older people in their own homes;
  • Preservation of dignity, autonomy and respect;
  • Although sensory impairment, vulnerability to and delayed recovery from illness may be features of advancing age, old age itself is not an adequate explanation or cause of physical or mental illness.
  • Older people in hospital, in their own home and in care homes should be treated with dignity following the recommendations in the Behind Closed Doors Campaign;
  • Older people in hospital, in their own home and in care homes should have their nutritional needs recognized.

Statutory Service Frameworks for Older People

Delivering High Standards of Care for Older People

Achieving the high standards of care will require:

  • Understanding of the needs of older people and a strategic plan to deliver services which address them;
  • Involvement of older people, including careers, in service planning;
  • Partnership working between primary care, local authorities
  • Recognition of the role and structure of the interdisciplinary team (defined as a group of nurses, doctors, specialist nurses, therapists, social workers, dieticians and other health professionals organised around the needs of older people or other patient group where leadership and composition of the team may change according to individual patient circumstances); and
  • Realignment of hospital based services to develop integrated specialist services for stroke, falls/fractures and osteoporosis, intermediate care support and mental health services for depression and dementia.

Implications for Specialist departments:

  • Older people must be represented, consulted and involved in local planning and decision making
  • All clinical policies are regularly reviewed to ensure no age bias;
  • Resuscitation policies are reviewed to ensure concordance with national guidelines;
  • Needs of ethnic and religious minorities are represented and incorporated in departmental protocols and local planning; and
  • Staffs of all types in care of older people units need to be empowered to challenge behaviors and help change attitudes in their own and other departments.
  • Person Centered Care
  • Older people should at all times be treated as individuals and offered choice in treatment, discussion and planning of future care. Services need to be modeled so as to be easy to access regardless of the end provider e.g. Health, Social Services or Private provider. This can be achieved through involvement of older people (including users and careers) in service planning, for example:
  • Utilization of the single assessment process;
  • Integrated community services to ensure rapid and flexible access to equipment; and
  • Ensuring a single point of access to services.

General Information

Older people may expect from specialist services:

  • To be involved in decisions made about their health and future care
  • Adequate numbers of appropriately trained staff
  • Clear and sensitively expressed explanations of their medical condition/illness unless their ill health prevents this, and of the treatment options available, in writing if required
  • If the older person wishes, this information will be shared with relatives, friends and carers
  • That relatives, friends or other advocate may give and receive information on their behalf, if the older person has difficulty in understanding or communicating and gives consent
  • Practical advice on appropriate support services and information to enable them to adapt to illness and disability
  • Written detailed information on local health and social services, voluntary organisations and on benefits
  • That support will also be available to their family and significant friends;
    Access to their health records and the security of knowing that everyone in the NHS is under a legal obligation to keep records confidential
  • Health premises accessible to people with disability and
  • Appropriate and punctual transport arrangements.

Discharge Planning and Equipment provision

The discharge of older people with high levels of dependency and complex health and social care needs requires careful planning, should be timely and to an appropriate location.

For more information please read The Discharge or transfer of care of frail older people

Intermediate care

Intermediate Care is conceived as a range of service models aimed at “care closer to home”. The two underpinning aims are, firstly, to provide a genuine alternative to hospital admission for some carefully selected patients and, secondly, to provide rehabilitation and supported discharge.

An intermediate care service should have a clear function (admission prevention and/or post-acute care), incorporate comprehensive (multi-disciplinary) assessment, have an enablement process, offer time-limited contact (to differentiate I.C. from maintenance services) and involve multi-agency working.

Community based care

Departments catering for older people in hospital should provide comprehensive services in the community to support general practitioners and primary care teams caring for older people. (The Specialist health needs of Older People Outside an Acute Hospital Setting.

Acute Assessment and General Hospital Care

Older people benefit as much from appropriate investigation and treatment as younger people and they are entitled to receive equivalent, efficient, timely and effective services as them. They are entitled to be treated with Dignity, compassion and humanity and their human rights should be respected. For more information please read Acute Medical Care for Older People.

Stroke

Accurate diagnosis and prompt treatment is essential in Stroke.

Older people are more likely to suffer from strokes and transient ischemic attacks simply due to ageing.

Prompt investigation (with urgent CT scanning) will allow appropriate acute therapy (i.e. thrombolysis for acute ischemic stroke) and supportive therapy (e.g. oxygen, intravenous fluids, nutritional therapy (where appropriate) and further therapy as required) to allow maximum recovery to take place.

Guidelines are in place to improve the standards of care and should be followed where appropriate (most should be read and considered by geriatricians and take into account for use in the whole of the UK).

For more information please read The Royal College of Physicians ( London ) National Clinical Guidelines for Stroke.

Falls

Thirty percent of people aged over 65 and forty percent of those aged over 75 fall over each year. Falls are associated with significant mortality and morbidity. Multi- component programmes and comprehensive geriatric assessment have been shown to be effective at reducing the negative consequences of falls.

Pain

Any health assessment of older people must include the identification of pain when present remembering that many of them will not acknowledge or report pain. If present standardized intensity rating will help measure severity.

Careful history taking and examination of the older person are essential to identify the location of pain.

It must be remembered that behavioural problems in older people with Dementia may often be caused by pain.

Mental Health Services

Good mental health underpins the well being of older people. Older people with mental health problems are entitled to have a diagnosis made and appropriate treatment initiated as recommended in the following guidelines.

Medicines and Older People

Medication offers older people the opportunity of enhanced life expectancy, enhanced functional independence and quality of life.

Older people are more likely to suffer from multiple diseases and hence be prescribed multiple medications increasing the likelihood of poor compliance and adverse drug reactions.

When prescribing for this group consideration must be given to risks and benefits.

Palliative Care

All older people at the end of life, wherever they are living, are entitled to holistic person centred palliative care equivalent to that provided to people suffering from cancer.