Dr Rajvir Kahlon is an ST5 in Geriatric Medicine at Royal Victoria Hospital. He is a BGS Northern Ireland council representative involved in the #ChooseGeriatrics campaign. In this blog, he shares the story of Northern Ireland-based geriatrician, Dr Elaine Nelson, which highlights the variety of work involved in a career in geriatrics.
When people think about geriatrics, they often picture holistic care in a ward setting provided to older people with multiple co-morbidities. Whilst this is true, this is only one facet of the role of a consultant geriatrician, and a much more varied career lies ahead for prospective geriatricians.
Dr Elaine Nelson, a consultant geriatrician working in the Southern Health and Social Care Trust in Northern Ireland, works in both hospital and community settings. She rotates between sites on a three-to-four monthly basis. From Acute Care at Home (ACAH) to Frailty at the Front Door, through to managing inpatient care for older adults, Dr Nelson moves between these very different settings with caring for her patients always at the centre of her work.
In the hospital
In her inpatient hospital work on the acute frailty unit, Dr Nelson, like all geriatricians, manages complex patients with multi-morbidity, frailty, polypharmacy, and cognitive impairment alongside a dedicated hospital multidisciplinary team (MDT).
Dr Nelson’s role is extending now into a Frailty at the Front Door team. This service, based in the Emergency Department, allows early identification of older adults living with frailty. Through this service, patients are proactively identified, leading to earlier comprehensive geriatric assessment. The aim is then to discharge them from hospital after MDT assessment, to discharge with ACAH back to the community or, if requiring admission, to source a bed directly in the Acute Frailty Ward or off-site rehabilitation beds. This prevents a hospital admission or improves the patient’s journey through the hospital, resulting in a shorter length of stay.
Dr Nelson’s on call work involves facilitating hyperacute care for patients presenting with acute strokes.
In the community
A change in environment marks the beginning of a new rotation with ACAH. For these months, Dr Nelson manages an MDT dedicated to providing acute medical care at home to older people in a community setting. Care is provided in older people’s homes, residential care, and nursing homes.
The mornings are spent completing post-take ward rounds, travelling to the homes of new patients referred to the ACAH team. Patients are assessed in their own homes, providing an invaluable insight into how the patient lives and manages in their home setting. In this environment, clinicians must rely more on their clinical acumen to assess patients but are supported with point-of-care tests such as arterial blood gases (ABGs), bloods, electrocardiograms (ECGs), and bladder scans. Point of Care Ultrasound (PoCUS) is another exciting investigation being introduced in the ACAH setting to identify pulmonary infections and heart failure, which is especially important for a cohort of patients living with frailty who cannot attend radiological investigations.
Midday signals the beginning of the ACAH multidisciplinary meeting at the ACAH hub. During these meetings, all patients are discussed collaboratively, and bespoke management plans are formulated for the next 24 hours. This ensures review of antibiotic courses and medications with early de-escalations or discontinuation.
Dr Nelson describes her time as part of the ACAH team as one of the highlights of her job. She feels privileged to be trusted by the patients that warmly invite her and the team into their homes.
A career rich in variety
Dr Nelson’s work shows that a career in geriatrics can be a most varied and rewarding career, enveloped by an ever-changing landscape from the bright lights of the hospital to the quiet glow of the lamp of an older patient wishing to be treated at home. A career in geriatrics is not just a job, but a vocation centred around caring for older people, regardless of the setting.
