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Scottish Care of Older People Audit

The evidence base for specialist led coordinated organised services is stronger than ever with an update of the Cochrane review expected imminently to conform that some benefits (avoidance of Nursing Home) may start as early as the point of discharge.

In other specialties such as Stroke or Orthopaedics (Hip Fracture), national audits and benchmarking of services have led directly or indirectly to a focus on improvement.  Often this has resulted in improved services.

In a partnership between the University of Aberdeen, Healthcare Improvement Scotland and BGS Scotland, we are announcing the development of a national benchmarking of CGA services.  This will be developed in an interactive fashion and we are not naïve to the scale and complexity of the challenge!  A similar (voluntary) exercise was undertaken in England and can be found here.

Longer term our hope is that this might also prove the springboard to investigate correlations between process and outcome in service delivery.

In the meantime however we plan to establish the metrics.  Whilst we would aim to make this as undemanding as possible for boards, we are likely to need close cooperation with colleagues at board level to collect data.

Meanwhile watch this space!  We hope to have a website available shortly to give updates on the development and progress of the initiative.

Graham Ellis
Phyo Myint

Hospital at Home Forum at the BGS Autumn Meeting

Dr Graham Ellis is an Associate Medical Director and Older Peoples Services Consultant Geriatrician for NHS Lanarkshire. He is also one of the key speakers at the Hospital at Home UK Forum at the BGS Autumn Meeting on Wednesday 23rd November in Glasgow. 

home-heartOlder people are presenting to acute hospitals in greater numbers year on year. Predictions of the future demographic raise serious questions about the sustainability of hospital based services. The Future Hospitals Commission recommended the development of specialist hospital services in the community delivering new and innovative services closer to the point of need.

Older people’s services in particular are challenged to meet existing and predicted demand. Recent headlines have highlighted inadequate alternatives to admission for older people. Yet older people should receive high quality, safe and effective care best suited to their needs that includes Comprehensive Geriatric Assessment. Services need to be designed from a patient centred perspective, but they must also be high-quality, safe and affordable.

Why do older people get less palliative care than younger people?

A paper written by Anna Lloyd and her colleagues, and published in the European Journal of Palliative Care analysed data from four studies into the end-of-life experiences of people with glioma, bowel cancer, liver failure and frailty. They found that patients aged 70 and over received less palliative care.

In summary, the team found that:

  • A secondary analysis of data from four studies on the end-of-life experiences of people with glioma, bowel cancer, liver failure and frailty suggests that older patients (aged 70 and over) have more untreated pain, less access to generalist and specialist palliative care, and greater information needs than younger patients
  • In older people, there are less clear early signs indicating that they need, and triggering their referral to, palliative care. The lack of a clear diagnosis of dying and the association of palliative care with cancer also hinders older people’s access to good end-of-life care.
  • More efforts should be made to identify older patients who would benefit from a palliative care approach in all settings.

Read the full paper here

Thousands of care home places lost since turn of the century

Thousands of care home places in Scotland have been lost since the onset of devolution prompting fears that the country’s “most vulnerable” are suffering and demands for government action. There are now claims that ministers have failed to plan for the impact of an ageing population, despite repeated warnings. But the Scottish Government says its policies are now directed towards ensuring that people can live independently to an older age in their own homes. The number of registered care homes places fell by 3,685 since the turn of the century to 42,026 last year, according to official Scottish parliament figures. This includes 83 fewer local authority and NHS places last year, 290 fewer spaces in private facilities, and 103 fewer in voluntary facilities compared to 2014.
Read more in The Scotsman

Which screening tool(s) should clinicians use for the detection of delirium in older, hospitalised patients?

Kirsty Hendry is a research assistant based at Glasgow Royal Infirmary having recently completed her PhD at the University of Glasgow. In this blog she discusses her recent Age and Ageing paper looking at screening of delirium in older, acute care in-patients. Kirsty can be contacted at Kirsty.Hendry0@gmail.com

A&ADelirium, suggested to be the most common psychiatric disorder suffered by older hospitalised individuals, has a low clinical awareness. This is despite existing guidelines such as those produced by the National Institute for Health and Care Excellence (NICE) and Healthcare Improvement Scotland (HIS) being in general agreement that delirium screening is important in older hospitalised patients. 

There are a number of negative outcomes associated with delirium including increased risk of falls, dehydration, long-term cognitive impairment, institutionalisation and mortality. Identifying patients with delirium is essential to facilitate good patient care and to allow for the appropriate support of relatives and carers. There are a wide range of delirium screening tools available with limited validation of these tools within large, representative cohorts. MOTYB How do clinicians go about screening for delirium effectively?

If it’s everyone’s business, lets make a plan

From the BGS blog: Pamela Levack is Medical Director of the charity PATCH – Palliation And The Caring Hospital contactus@patchscotland.compatch

David Oliver’s recent blog in the BMJ End of Life Care in hospital is everyone’s business, reports on the findings of the recent Royal College of Physicians Audit into End of Life Care. The two main findings, a need to increase the number of specialist palliative care doctors and specialist palliative care nurses in hospital and to ensure that newly qualified doctors have more knowledge and confidence dealing with end of life situations, match the aims of our recently established charity PATCH Palliation And The Caring Hospital.

PATCH is presently a Scottish charity but the issues are the same throughout the UK. It was inspired by the Acute Palliative Care Unit in Ninewells Hospital, Dundee. This was established in 2009 with charitable money but is now NHS funded. Based on ten-year hospital palliative care team data, we believe there is a population of patients in a busy acute hospital who benefit from an intensive palliative care approach from a number of disciplines including social work, occupational therapy, physiotherapy, pharmacy, spiritual care, and pain service in a dedicated on site unit.

A life-course perspective necessary to improve the health of older adults

Dorota Chapko is a PhD candidate in Public Health at the University of Aberdeen in Scotland, and a graduate from the Massachusetts Institute of Technology (MIT) with a double-major in Brain & Cognitive Sciences and in Anthropology. In this blog she discusses her recent Age & Ageing paper on the triad of impairment; she tweets at@dorotachapko

Although frailty is a central concept in clinical assessment of older people, there is no consensus definition. The concept is certainly multifactorial but physical components dominate. However, it is known that age-associated physical decline is likely to be accompanied by cognitive and emotional deficits. The ‘triad of impairment’ (triad) recognises the co-occurrence of cognitive, emotional and physical deficits in late-life and might be a useful alternative to ‘frailty’.

Challenging the depiction of delirium in the media

The media’s portrayal of vulnerable elder people as ‘perpetrators of assaults’ shows us just how far we still have to go.

Dr James Woods is a registrar in Geriatric and General (Internal) Medicine in South East Scotland. He tweets at @jmwoods87

Earlier this week BBC Radio 5 Live ran a piece with corresponding BBC website article reporting on figures obtained from an NHS Protect report on physical assaults against NHS staff in England. The headline and corresponding analysis focused on patients over 75 years old as the most frequent ‘perpetrators of assaults’ against NHS staff. If you care about the healthcare needs of older people and want to see them treated with dignity and respect (which if you are reading this blog you probably do) then this makes for distressing reading.

Emotive language does these vulnerable people a huge disservice. Not only are they referred to as ‘perpetrators of abuse’ (a hugely pejorative title) in the headline but their actions were repeatedly described as ‘lashing out.’