Cassandra Leese is a Nurse, Clinical Supervisor and a wannabe dog owner. She occasionally remembers to tweet @contrarylass
In today’s economic climate, when health and social care are really feeling the crunch, I often find myself feeling morose about the future. Day after day we see the terrible pressures our overstretched services are under, read about the heartbreaking death of another promising doctor burnt out from battling it out in secondary care; or hear about another valuable service making drastic cuts. And selfishly, I’m rather cross that all this seems to have come at a time when I’m incredibly excited to have finally found my place in the nursing landscape, that of gerontology and geriatrics. Coming along to my first BGS West Midlands meeting this spring was a welcome reprieve from the madness spewed daily by the tabloids and renewed my faith that the good guys are still out there!
After nursing older adults on the ward, in the ITU, the outpatient clinic, the community, the hospice, the GP surgery and most recently in a retirement community, I have found the most common complaint to be “I’ve got a doctor for my heart, one for my hip, another for my eyes and another for my skin, but no one to piece it all together”. Not all patients are lucky enough to be seen by a geriatrician and GPs have a mere ten minutes to work their magic against increasing demand, so I was delighted when I stumbled across a role that enabled me to spend a little time with older people, piecing the bits together.
In my current role, I run a wellbeing service in a retirement village unlike any I’d ever heard of. Many of the older adults here are fitter than some of the staff that work within this unusual community in a bid to keep older people active, out of hospital and engaged in fulfilling life’s purpose – whatever that may mean to each individual. There is a strong focus on health and wellbeing, activities, volunteering and flexible care if needed.
I hold drop in clinics in the morning and conduct comprehensive health assessments in the afternoon, assessing, planning interventions, signposting and referring as needed. Research conducted by Aston University found that within the ExtraCare setting, NHS costs were reduced by 38%, the duration of unplanned hospital stays was considerably reduced and there was a 46% reduction in GP visits. Significantly, 19% of residents who were identified as pre-frail returned to a resilient state 18 months later at follow up. In real terms this means that Lily no longer needs or uses a stick to walk, Peter avoided hospital admission after medication interventions and Jim has lost a stone in weight, is now a regular gym user and no longer needs analgesics for arthritic pain.
ExtraCare, in collaboration with Aston University, have gone on to develop and pilot a frailty calculator called the resilience tool, and built it into the baseline and annual assessments offered alongside the daily drop in clinics. These assessments, to my mind, now share many of the elements needed for the comprehensive geriatric assessment I keep reading about, and I can’t help wonder about the potential value of sharing our findings and the possible application outside of our setting. Alas, health care professionals often seem to struggle to communicate; possibly because we’re all struggling to meet demand with fewer and fewer resources!
I’m lucky enough to have the time to spend 1-2 hours with an older person and assess gait speed, grip strength, self-reported health, social support, cognitive health and falls history, amongst other factors. If I find a patient struggling with mobility I refer to our gym or if indicated, a physiotherapist; if I find polypharmacy causing issues I can refer to our pharmacist and continue on to systematically address all the unmet needs raised in the assessment, culminating in patient led goal setting. To me, given the lack of time and the limited resources for CGA in the NHS, the next step is finding a way to work more closely with NHS colleagues to ensure that work isn’t duplicated or inadvertently increased. How might the future look if social care, the third sector and health care could find a way to pool our knowledge and work together more collaboratively?
I hope I get to find out.
Reference: Holland C, Carter M, Cooke R et al (2015) A Longitudinal Evaluation of the ExtraCare Approach. Aston Research Centre for Healthy Ageing. Aston University. Available from: http://www.aston.ac.uk/lhs/research/centres-facilities/archa/extracare-project/ [Accessed 2nd May 2017]