Acute care for older people

Dr Simon Conroy is Head of Geriatric Medicine, University Hospitals of Leicester, Honorary Senior Lecturer, University of Leicester and an Associate Editor for Age and Ageing journal.

Acute care for older people appears to be the topic de jour. The increasing number of older people attending acute care should not be a surprise given the demographic pressures, yet many hospitals still appear slightly taken aback by the increasing age, complexity and number of patients accessing urgent care.

A range of efforts to reduce hospital attendances do not appear to have attenuated the patterns over recent years. GPs are being performance managed on avoidable admission, emergency departments are beholden to the 4-hour wait and in-patient teams are hounded on a daily basis to discharge yet more patients.

Is there a better way? We hope so. At a forthcoming conference hosted by the Royal College of Physicians, we will bring together relevant stakeholders to share ideas and thoughts about how to make things better. Importantly the speakers represent all stages of the patient pathway.

The first session will set the stage with the global perspective putting the UK experience in to context, followed by the patient perspective which must be at the heart of all that we do.

After some excellent College Coffee, pre-hospital pathways will be examined, ranging from the role of the GP (the key orchestrator of community services), the ambulance service (with thoughts about extending the role of the paramedic) and a look at virtual wards (their form, function and performance).

After lunch (sadly without access to the college wine collection), we then move into the engine rooms of the hospital – the emergency department and the acute medical unit. Both high pressured settings, both with a flair for experimentation and change, driving forward patient safety and improving outcomes.

The final session will bring the patient pathway together with thoughts about discharge planning and a glimpse at future hospital configurations.

We hope that the day will bring together consultants and trainees who undertake general medicine as part of their clinical service, consultants and trainees in acute medicine , nurses working in the AMU environment and primary care clinicians with a responsibility for intermediate care and community rehabilitation.  In collaboration with geriatrician colleagues, we all need to think about the whole patient journey for a frail older person and the role of all the different services across primary and secondary care and how they might come together for the better. See you there!

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