The Future Hospital Commission: future-proof doctors need training in geriatric medicine

Dr Adam Gordon is a Consultant and Honorary Associate Professor in Medicine of Older People at Nottingham University Hospitals NHS Trust. He is Deputy Honorary Secretary of the British Geriatrics Society and also edits this blog. 

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The report of the Future Hospital Commission, published last week, suggested we needed “a cadre of doctors with the knowledge and expertise necessary to diagnose, manage and coordinate continuing care for the increasing number of patients with multiple and complex conditions. This includes the expertise to manage older patients with frailty and dementia.”

The most evidence-based way to manage frail older people is Comprehensive Geriatric Assessment (CGA). CGA has consistently been shown in large meta-analyses and systematic reviews over the last 20 years to improve outcomes for older patients. These include – but are not limited to – decreased risk of cognitive decline and death, increased likelihood of functional independence and a lower probability of readmission to hospital.

Doctors don’t “do” CGA – it is delivered by a multidisciplinary team (MDT). It requires assessment across multiple domains (medical, psychological, environmental, social and functional), accompanied by case management and iteration of management plans.  The role of doctors is to provide diagnosis and prognosis, to initiate medical treatments where necessary and to do so with consideration to the broader management plan agreed with the MDT.

If doctors are to do this they need first to understand how CGA works. Continue reading

The future of hospitals is age-attuned

Prof Paul Knight is President of the BGS and is Director of Medical Education and Consultant Physician at the Royal Infirmary, Glasgow.

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The Future Hospital Commission (FHC) has published its report and recommendations for ensuring that hospitals are designed around the needs of patients. The report recognises that older, frail and more complex patients with multiple long term conditions are the main patient group cared for in modern hospitals. It is critical that we meet the needs of these vulnerable individuals.

The FHC places welcome emphasis on the importance of Comprehensive Geriatric Assessment (CGA) but at the same time there are significant workforce implications for the expanded use of CGA in general hospitals.

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