Hospital Dr News

Toolkit aims to improve care for frail elderly

A new toolkit for acute medics aims to improve the care for frail older people.

Older people make up to 70% of hospital inpatients, and most are admitted through an Acute Medical Unit (AMU), making this a key area in which care for older people can be influenced.

However, it can be difficult for doctors to assess frail older patients as they can often arrive at hospital with multiple symptoms or conditions which can make it difficult to deduce the true cause of the admission.

The toolkit from the Royal College of Physicians , produced in collaboration with the British Geriatrics Society, recommends procedures for both initial assessment on admission and later Comprehensive Geriatric Assessment (CGA).

The toolkit has a 30-second guide to frailty syndromes that will help doctors distinguish between a variety of possible conditions underlying the frailty (such as falls, delirium and dementia, and incontinence), which the RCP believes will lead to better diagnosis, fewer unnecessary admissions, and a reduced need for long-term care.

In addition to communicating effectively with the patient, doctors should also talk to carers or relatives if possible to get a full picture of the older person’s illnesses and how they are being treated, which can save unnecessary investigations and treatment.

If a frailty syndrome is detected, a fuller assessment should be considered. Services should be set up to deliver comprehensive geriatric assessment (CGA), in which a multidisciplinary team not only assesses the medical health of the patient, but it also assesses the patient’s mental health, their capacity to carry out daily activities and exercise, their social circumstances and what kind of support they have, and their home environment.

A typical multidisciplinary team to deliver CGA would be a geriatrician, nurse specialist, occupational therapist, pharmacist and others as needed, (e.g. speech and language therapist, dietitian).

The toolkit recommends domains for assessment, models of care and a whole systems approach across primary and secondary care, and health and social care interfaces.

As frailty issues are so common in the AMU, the toolkit suggests a need for a lead clinician to be based there to focus solely on these issues.

Dr Simon Conroy, lead author of the toolkit, said: “The British Geriatrics Society is delighted to support this important initiative to establish the best care for older people in acute medical units. Holistic assessments in the acute medical unit will improve patient outcomes and service efficiency.”

Dr Mark Temple, RCP acute care fellow, said: “Older people are more likely to have an emergency medical admission and stay longer in hospital. However the clinical assessment of frail older patients can be difficult. This toolkit is important as it focuses on the assessment of acutely ill older patients and getting this right can have an enormous impact on the quality of care and patient outcomes.”

Download the toolkit.

Dr Simon Conroy will be speaking about the management of frail older people in the emergency setting at Acute and General Medical Conference in November. Register to attend here.

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