One of the greatest paradoxes of the age is our dramatically increased life expectancy and a consequential growth in the population of elderly people. While this is indeed a testament to the remarkable advances in medicine and quality of life, the sword remains very much double-edged.
The baby-boomers came into this world in vast numbers following the devastation of the Second World War, and now make up a significant percentage of the 11.4 million people currently over the age of 65 in the UK. That number is set to pass 20 million by 2030, which inevitably puts an enormous pressure on public services and society as a whole to effectively adapt to this change. As far as healthcare is concerned we are faced with several challenges, all of which are very much interchangeable.
Within the last ten years, hospital admissions for patients over the age of 75 have increased considerably with the number of readmissions climbing higher still. The question being asked is why these readmissions are occurring and how they can be better prevented.
With doctors facing continual pressure time and resources at hand to conduct a proper assessment. Thus underlying problems may go unnoticed and readmission becomes more likely.
Which is where ‘frailty units’ come in. These pioneering units have so far been introduced into 20 UK hospitals and provide specialist care for geriatric patients on point of entry. Here, each patient gets a full MoT in a bid to discharge them at the door, freeing up beds and reducing admissions. Most important however, is the care and attention given to elderly patients by doctors and other healthcare professionals who understand the difference in working with people of that age.
It has recently come to light that newly qualified doctors are not undergoing enough training to prepare them for the needs and requirements of older patients. A major poll of British medical schools revealed a jarring discrepancy between the proportion of medical workloads made up of diagnosis and management of frail older people, and the amount of undergraduate teaching devoted to it. Simple yet pressing issues such as elderly abuse and pressure sores are not being discussed enough during training.
This shortage of doctors adept at geriatric care inevitably has a knock-on effect on everything from misdiagnosis to the general health and wellbeing of older patients, who are then more likely to be readmitted further down the line. Or indeed whose hospital stay will be far longer than necessary – tarring them with the brush of being ‘bed blockers’.
Another solution therefore is to take a more comprehensive approach to care for elderly patients. Much like the frailty units provide a battery of checks and assessments, an aging population will require more doctors to provide services outside of hospitals and practices – tending to patients in their own homes and working with other healthcare professionals to draw up a comprehensive plan.
It is just as beneficial for doctors to work with families in order to encourage a collective support system that will enable more prompt discharge from hospital. This means discussing medications and care advice, as well as offering a supplementary service of regular check-ups and holistic care.
Unfortunately, we have hit a situation where there are more elderly patients and fewer doctors with the specialist knowledge needed to provide such care. Geriatricians are hard to come by and yet in growing demand.
Older people are naturally prone to multiple chronic conditions and all the medications that come with them, as well as functional limitations and disabilities. They also require the kind of care and attention as befits anyone who has lived a long time – care that is sympathetic to the discrepancies of an aging mind that can become confused and forgetful, or hearing that may not be as sharp as it once was.
