Uncontroversial truths; Discussing urgent care for older people

Stuart Parker is Professor of Geriatric Medicine at Newcastle University and a consultant physician at Newcastle upon Tyne Hospitals NHS Trust where he is helping to develop an acute inpatient service for frail older people. Here he discusses the Urgent care for frail older people – Hospital Wide Comprehensive Geriatric Assessment Meeting on 25 May in Leeds.

Frailty is now widely recognised as a key component of declining health and function in old age.  Older people with urgent care needs are particularly likely to experience frailty.  New acute illness can trigger the onset of frailty in an older person who, in whom the limits of their functional capacity may be urgently revealed. Older people are increasingly the main users of urgent care services. Accordingly, urgent care services for older people need to be able to recognise, evaluate and manage frailty. Continue reading

Using a frailty index in the Emergency Department

Dr Audrey-Anne Brousseau is the first fellow in geriatric emergency medicine in Canada. She was recently appointed as assistant professor at the Université de Sherbrooke in Quebec. Her work focuses on developing best practices for older adults in the emergency department.

EDs are often the safety net of the health care system where the mission is to (rapidly) evaluate, intervene and organize transitions of care. With the aging of the population and the growing presence of older adults in EDs, this mission represents a significant challenge because older adults are complex on multiple levels.

How do we determine whether a patient is fit to go back home — or not?  Needs admission —  or not? Would benefit from rehabilitation, additional community services, further assessment — or not?  A comprehensive geriatric assessment will provide this answer, but is rarely readily available in most EDs. Moreover, human and material resources are often limited in public health care system preventing all older adults ED patients to get a geriatric assessment and appropriate interventions. Continue reading

Blue Ribbon Patient: Do Not Transfer

Rick Strang RN is Emergency Care Improvement Lead at Isle of Wight NHS Trust in England. When not involved in all types of emergency care Rick is usually finding innovative ways to avoid household chores.

Most of us across acute care have been involved in late night bed pressures that call for that dreaded decision to need to move some patients around between wards. Typically we see the only beds available to be surgical ones whilst the demand is for acute medical beds. Moving acute medical patients directly to these outlying beds from the emergency department (ED) may present too much of a risk. Lower acuity patients from acute wards are therefore often sought out to be transferred into these surgical beds thus making way for the more acute ED demand. End of Life (EoL) patients seem particularly at risk of being moved, which can be very distressing for families, friends, the patient and the care teams. Continue reading

Dying with dementia – we need to measure more than the place of death

Katherine Sleeman is an NIHR Clinician Scientist and Honorary Consultant in Palliative Medicine at the Cicely Saunders Institute, King’s College London. In this blog she discusses her paper Predictors of emergency department attendance by people with dementia in their last year of life: Retrospective cohort study using linked clinical and administrative data. She tweets @kesleeman

Over the past decade there has been a strong policy focus in the UK and elsewhere on dying out of hospital as a marker of good quality of end of life care. We have previously shown that, for people with dementia, hospital deaths have fallen over this time period, possibly as a result of these policies.

However, it is increasingly recognised that the place of death is an imperfect proxy for the quality of end of life care, providing little more than a snap shot of where a person was in their last moments. Continue reading

Take time to talk! The importance of an informant history

Adam Dyer is a Final Year Medical Student in Trinity College Dublin. Dr. Sean Kennelly (MB PhD FRCPI) is a Consultant Physician in Geriatric and Stroke Medicine in Tallaght Hospital (Dublin, Ireland) and a Clinical Senior Lecturer in Medical Gerontology at Trinity College Dublin (TCD). The following work was presented as a platform presentation at the 64th Irish Gerontological Society Meeting in Killarney, Ireland (October, 2016).

Imagine you’re seeing a consult or you’re on a post-take ward round. How often do we examine a patient and identify cognitive deficits, see that the CT brain scan report and the MMSE score are readily on hand, but then ask staff about the patient’s premorbid cognition and function and are met with blank expressions?

An important factor which complicates the presentation of older people to acute hospitals is the presence of impaired cognitive status (either in the form of dementia, delirium or both). Continue reading

Blue lights and sirens; A Paramedic’s perspective of caring for older people

Duncan Robertson is a Consultant Paramedic with the North West Ambulance Service. He has an interest in falls and frailty and a research interest in the lived experience of frailty in the 999 population. He tweets @NWAMB_Duncan

DuncanIf, like me, you spent your formative years watching Saturday night television on the BBC, you may have a particular view of the ambulance service.  Through popular dramas and fly on the wall documentaries more people than ever have an insight into the work of the Paramedic.  We deal in saving lives; we come to you when you have had a road traffic collision, a stroke or a heart attack, we perform heroic resuscitation, we treat stabbings, shootings, assaults and intoxicated revellers on weekend nights.  We use blue lights and sirens, arrive by ambulance, response car, motorcycle, bicycle or helicopter and we must see some sights…or so we are told! Continue reading

Why should we have a ‘geriatric’ emergency department?

5922817362_8fd01d909b_oRosa McNamara is a consultant in emergency medicine in London, with a special interest in geriatric emergency medicine. She tweets @rosamcnamara

So we all know that the world is growing older – it is now common for emergency department (ED) clinicians to spend the majority of their day looking after frail older adults. In emergency medicine (EM) we are going through a longish period of reflection on how best to care for older adults (EM is just over 40 years old, and for 30 of those years there has been discussion about this). Interest in the needs of frail older adults has widened and many solutions have been tried in EDs worldwide, with mixed results. These include rapid response teams, liaison geriatrics, interface geriatrics and the development of seniors EDs.

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Systematic review of Emergency department community transition strategies

aaJudy Lowthian is a researcher at Monash University’s School of Public Health and Preventive Medicine. Here, she discusses a new systematic review published in Age & Ageingwhich looks at various emergency department community transition strategies (ED-CTS) to determine their efficacy.

Emergency Department patients aged 65 years and over are increasing at a faster rate than the ageing population. These older individuals have longer stays in the emergency department and a higher chance of admission due to various psychosocial and medical problems. They also often need increased resources to better comprehend their reason for presentation. Clinicians are also under the strain of meeting time-based targets, managing the flow of the emergency department, maintaining adequate quality of care and accounting for appropriate resource allocation.

Continue reading