Page 83 - Hospital Authority Convention 2018

Symposiums

S2.1 Acute Care for Frail Older People 14:30 Convention Hall A

International Experience in Managing the Fastest Growing Population in Acute Care: Complex, Frail Older
Patients
Rockwood K
Department of Medicine, Division of Geriatrics, Dalhousie University, Canada HOSPITAL AUTHORITY CONVENTION 2018

Population ageing poses an existential threat to many healthcare systems, especially to hospital care. Most such systems
are organized and funded on a model of otherwise well patients, who present with a chief complaint that represents a single
organ/single issue problem. Typically, the systems assume that these uncomplicated patients can easily be discharged once
treated. “Exceptions” are understood to exist, but are felt not to properly be the hospital’s responsibility.
The goals of this session are:
(1) to illustrate why population ageing and illness complexity are linked, and to demonstrate the intrinsic relation between
frailty and ageing. We will review how health deficits accumulate across the life course, reflecting a typically decades-long,
subclinical period of slow decline in repair capacity;
(2) to review how frailty impacts on disease presentation. Here we consider how the “geriatric giants” (e.g. delirium, functional
decline, immobility, social abandonment) relate to illness acuity and to how complex systems fail;
(3) to outline how to screen and assess for frailty in prehospital care and in the Emergency Department. The focus is on
usable tools and on obtaining collateral information rapidly and with empathy;
(4) to illustrate how frailty assessment links prognosis and care planning. We will discuss the interplay between illness acuity
and the degree of underling frailty. This is recognised as a challenging area, and ripe for additional research to provide
insights that can help on an individual basis.
This presentation will also make the point that the challenges for better care of older adults consist in not just in a better Monday, 7 May 2018
understanding of the facts surrounding ageing, but in the willingness to engage with the complexity of illness – especially
acute illness – in people with complex medical and social needs.

S2.2 Acute Care for Frail Older People 14:30 Convention Hall A

Interdisciplinary Care for Frail Older People in Acute Setting in the UK
Banerjee J
University Hospitals of Leicester NHS Trust, UK

Older people are increasingly the most important and impactful users of acute care services in the UK. Over the last few
years there have been many community initiatives to reduce hospital usage in this group with variable results. Over the same
time there have been initiatives in the acute setting to better respond to this increasing challenge. These have had variable
clinical and cost effectiveness. Despite all these, recent data from the UK suggests that frailty in older people is having a
multiplicative effect on care home admission, hospitalisation and mortality with the highest impact in one year but continuing
into years three and five. There is a paucity of evidence for any local or regional initiative having had any meaningful impact
on reducing acute activity in frail older people. Frailty affects all aspects of care including prescribing, and successful
interventions had affected specific frailty syndromes affecting people in care homes and at end of life. Comprehensive
geriatric assessment delivered by interdisplinary teams is an evidence based intervention that can improve outcomes in older
people. However this needs to be systematised across a whole system and implementation at local, regional and national
levels are being targeted through integrated systems and quality collaboratives. Their impact remains to be evaluated.

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