Page 150 - Hospital Authority Convention 2017

Symposiums
HOSPITAL AUTHORITY CONVENTION 2017

S7.1 Geriatric Care 09:00 Convention Hall C

How to Deal with the Frail Elderly at the Hospital Front Door
Oliver D
Care Quality Improvement Department, Royal College of Physicians, UK
Population ageing has changed the nature and core business of acute hospital care. The average age of patients presenting
acutely to Emergency Departments and Acute Medical Services is older, with many over 80. The highest relative cost is also
for those patients. This in turn has changed the nature of acute adult care and so our services must change to reflect this.
(https://www.rcplondon.ac.uk/projects/outputs/future-hospital-commission)

Many older people have single diseases, are in overall good health and their needs are little different to those in mid-life.
However, many of those calling ambulances, presenting to the acute hospital “front door”, cared for on deeper wards within
the hospital, or seen in rapid access ambulatory care clinics have age-specific problems.

In particular, they are more likely to suffer from multiple long term conditions, often related to age, often accompanied
by polypharmacy. They often have dementia which accompanies their other medical problems and complicates their
presentation and management. Age-related disability is also prevalent as is reliance on support from family caregivers.

Of especial importance is the concept of frailty. Older people with frailty often have poor functional and homeostatic reserve
(Clegg, Rockwood et al). They often present to acute care systems with syndromes such as falls, delirium, rapid loss of
mobility or functional independence or non-specific failure to thrive. Even relatively minor illness or injury can precipitate
such crises. Stress and concern among family caregivers is another common trigger. Some present close to the end of life.
Because loss of function in the face of acute illness also complicates frailty, they often need skilled post-acute rehabilitation.

Comprehensive geriatric assessment delivered by skilled multi-disciplinary teams, including geriatricians, can improve
outcomes for older people with frailty in acute care.

We need to adapt what we do to identify people with frailty more systematically, to provide effective rapid community
responses in crisis and ambulatory alternatives to hospital. But when they do present acutely, expert early assessment and
intervention with access to rapid community alternatives can often keep them out of hospital. And if they do come in we
should do all we can to prevent complications of hospitalisation, to prevent functional decline and to return them home as
soon as is safe.

References:
The Silver Book on Urgent and Emergency Care – http://www.bgs.org.uk/campaigns/silverb/silver_book_complete.pdf
Scottish Older People in Acute Care, (OPAC) project
Frailty a clinical review, Clegg, Rockwood et al Lancet– http://thelancet.com/journals/lancet/article/PIIS0140-6736(12)62167-9/
abstract
Future Hospital Commission – https://www.rcplondon.ac.uk/projects/outputs/future-hospital-commission - RCP website
Wednesday, 17 May

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