Feb 20, 2018

More Patience for the Elderly Needed in the Emergency Departments

Australia has an ageing population, and with that come a growing number of older people being admitted to hospital.

According to the Australian Institute of Health and Welfare, approximately 41% of all hospital admissions were for people over 65. Many of these people are elderly, frail and may have other medical conditions, such as dementia.

Older people who are admitted to hospital need to be treated differently to how a younger person or a child is treated.

This is usually due to the ageing conditions they may have, such as dementia, and other comorbidities.

Older people also often have lower body reserves, which mean that even minor issue such as diarrhoea or a fall can be potentially life-threatening

A 2011 study analysed the results of how more comprehensive geriatric assessments could help older adults admitted to hospital.

What it found was that “comprehensive geriatric assessment increases patients’ likelihood of being alive and in their own homes after an emergency admission to hospital”.

A comprehensive geriatric assessment (CGA) is defined as a “multidimensional interdisciplinary diagnostic process focused on determining a frail older person’s medical, psychological and functional capability in order to develop a coordinated and integrated plan for treatment and long term follow up.”

“Significantly more older patients are likely to survive admission to hospital and return home if they undergo comprehensive geriatric assessment while they are inpatients,”  at a median follow-up of 12 months compared with patients who received general medical care.

“Fewer will die or experience deterioration and more will have improved cognitive functioning. These effects of acute geriatric medicine programmes are consistently shown in trials of geriatric wards but are not replicated in trials of geriatric consultation teams on general wards.”

And one other benefit that was found was that undergoing such assessments might be cost effective, in that having an assessment done earlier will lead to fewer hospital trips in the future.

According to experts, there are support systems that need to be in place to help older people and decrease the likelihood of re-admissions.

Another article published in Age and Ageing by the Oxford University Press reviewed the evidence behind performing comprehensive geriatric assessments (CGA) for more elderly patients that present at the emergency department also.

The results showed that the admission rates in the emergency setting was considerable reduced by completing geriatric assessments without compromising the holistic and specific care to older patients. The patient assessments have shown to reduce costs when using the comprehensive geriatric assessments required for the geriatric population as well as to increase their health outcomes.

One example is having a GP who knows the patient’s conditions and history well, who are also able to monitor the older person once they have discharged.

There have been talks about creating a separate emergency department just for older people in the past.

In fact, this was done in the UK where one hospital created their own emergency department for elderly patients. Norfolk and Norwich University Hospital were the first specialist emergency department for people who are over 80 years old.

 

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  1. We had a client, and 84 year old lady with dementia, taken to hospital by ambulance for an X-ray in the middle of the night after a fall. The nursing home where she lived did not have any staff available to accompany her (most homes operate at night with a skeleton staff) and the busy emergency department did not see her for hours. She spent a night in a strange, noisy and busy place by herself, frightened and in pain.

    This was a case of passing the problem along. The nursing home did not have time to deal with a potential broken hip, even though, with pain killers, it could have waited until morning. There was nothing to be gained by sending her to hospital in the middle of the night. It also shows the lack of facilities available for elderly people in emergency.

  2. There is a huge absence of Geriatric trained health card professionals in most countries save perhaps Japan where they take an
    pro-active approach to older persons’ needs and Denmark as another example of pro-active intervention s before a trip to the Er is needed.
    A meta analysis of the best approach for frail older persons is to intercept them before they are admitted to the slippery slope in the Emergency unit. In fact having a geriatric team available to consult with the older person/family in a UK research project to keep older persons out of hospitals with the use of Geriatric teams was so effective in reducing the ED visits and admissions to zero during the research study.
    This would have a huge impact on the non- use of ALC beds in acute care centres and lessen the chances of premature admission to LTC facilities. Returning the older person back to their ho e and following them can be done economically if one were to employ the Buurtzorg Neighbourhood Card (BNC) model from the Netherlands. The health care money saved would likely pay for services and programs such as the BNC to provide consistent, efficient snd appropriate care snd referrals to other programs and services, it could advance the desired Aging in Place model versus institutional living and the dangers of those in times of public health emergencies.
    Dementia patients tend to do much better (adjust to the normal environment of a real house) and settle into routines that help reduce the anxiety and fear. Thereby being able to employ non-pharmaceutical interventions because trained staff would now have the time to provide truly person-cantered care.
    Both are worth trying.

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