How do geriatricians improve outcomes after hip fracture?

Jenny Neuburger is a Senior Research Analyst at the Nuffield Trust  (@NuffieldTrust) and a Visiting Research Fellow at the London School of Hygiene & Tropical Medicine. She and her co-authors have recently published research in Age and Ageing journal.

hipWe have just published a paper showing that geriatrician involvement in hip fracture care can improve patient outcomes.  Patients treated on wards with higher numbers of geriatrician hours tended to have lower mortality within the 30 days after presentation.

We measured geriatrician hours worked in orthopaedic departments using data collected via the National Hip Fracture Database annual survey each year from 2010 to 2013 for English hospitals.  Over this period, geriatrician hours increased from 1.5 to 4.0 hours per patient, reflecting investments made in response the financial incentives introduced under the Best Practice Tariff scheme. Continue reading

Making hospitals fit for the frail older people who actually use them

David Oliver is a Consultant Geriatrician in Berkshire and a visiting Professor in Medicine of Older People at City University, London. He is President Elect of the British Geriatrics Society. He recently wrote on the subject of frailty for the Nuffield Trust Blog:

On June 9, I finished my ward round of 24 inpatients – median age 80-plus, legged it to the station and got into London just in time to set up my workshop on models of care for frail older people at the Nuffield Trust Future Hospitals conference.

At the event, I presented some challenging ‘home truths’ alongside an animation and some practical solutions.

The “home truths”

1. With rapid population ageing especially in the over 80s. However much we invest in prevention and healthier lifestyles there will be more people with multiple age-related long-term conditions including dementia; multiple medications; more people with frailty syndrome (and related presentations such as falls, acute confusion, incontinence, and mobility problems) which worsen dramatically in the face of acute illness, leading to long-term disability without adequate post-acute rehabilitation, more dependence on support from carers and more people using multiple health and care services suffering from fragmentation. It’s a fact, Jack.

2. These people are increasingly the “core customers” of our servicesincluding bed-based acute ones. Even in places which have invested heavily in senior front door decision makers, case management or schemes badged as “admission prevention”, many of the older people who make it into hospital really are sick and do need to be there. It’s just that they then stay too long. Hands up who thinks a broken hip, an acute stroke or severe sepsis should be dealt with “in the community”?

3. We don’t have enough credible responsive alternatives outside hospital, as shown in the national intermediate care audit. You can only define “inappropriate bed occupancy” with reference to what else is available. Often the capacity just isn’t there and of course the evidence for admission prevention at pace and scale in frail older people is patchy at best.

4. The notion that we are over-bedded is dubious. We have lost one third of our acute beds in England over the past 20 years and have fewer per capita beds than any OECD country bar Sweden. Our hospitals run very close to full capacity which is bad for efficiency and patient flow.

Let’s get care right for the people who actually come to the front door instead of wishing them away. Systems, attitude and values – age, dementia and frailty attuned.

Click here to read the full article on the Nuffield Trust Blog.

View an animation by David Oliver and Health Service Journal Comment Editor Andy Cowper on the care of frail older people in hospital. The animation looks at the gone wrong care of Mrs Andrews, showing how essentially caring and well-trained staff can still let a frail older person down because the system isn’t geared for their needs.