British Geriatrics Society

Transforming care for older people in hospital: physicians must embrace the challenge

Published in Clinical Medicine 2012, Vol 12, No 3: 230 - 4: Professor Oliver says:

"The English National Health Service (NHS) is caught in a ‘perfect storm’ relating to older people’s care in hospital. A recent series of reports repeatedly highlights a picture of poor or variable care and a once-in-a-generation opportunity to transform services, which physicians must grasp."

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"So how can we as physicians respond to Ham’s ‘call to action’ to ensure that high-quality, safe, dignified and person-centred care for older people in our hospitals becomes the norm? First, our training, priorities and attitudes need to catch up with the impact of population ageing on the nature of modern medical practice. Hospitals and medical specialities emerged in an era when many people died in childhood or midlife of single diseases. In 2012, the main activity of general hospitals is the care of (generally older) people with (multiple) long-term conditions.

These are often accompanied by frailty, social vulnerability, dementia, functional or sensory impairment, and compounded by acute illness. Older patients often present acutely with syndromes such as falls, immobility, delirium or non-specific ‘failure to thrive’. The care of such patients has not featured highly in traditional medical textbooks or medical training..."

"Incontinence is not just about responding to call bells and cleaning up patients. They need a diagnosis and treatment plans, which we often fail to deliver. Poor nutritional care is not merely about caring nurses helping older people to eat. It requires skilled assessment, investigation of underlying causes and medical engagement."