The third in the series of acute care toolkits from the Royal College of Physicians aims to improve the care of the frail older patient.
Older people make up 60–70% of hospital inpatients, and most are admitted through an Acute Medical Unit (AMU), making this a key area in which care for older people can be influenced. It can be difficult for doctors to assess frail older patients as they can often arrive at hospital with multiple symptoms or conditions which can make it difficult to deduce the true cause of the admission.
The new six-page toolkit, produced in collaboration with the British Geriatrics Society, recommends procedures for both initial assessment on admission and later Comprehensive Geriatric Assessment (CGA).
The toolkit has a handy 30 second guide to frailty syndromes that will help doctors distinguish between a variety of possible conditions underlying the frailty (such as falls, delirium and dementia, and incontinence), leading to better diagnosis, fewer unnecessary admissions, and a reduced need for long-term care.
In addition to communicating effectively with the patient, doctors should also talk to carers or relatives if possible to get a full picture of the older person’s illnesses and how they are being treated, which can save unnecessary investigations and treatment.
If a frailty syndrome is detected, a fuller assessment should be considered.
Comprehensive geriatric assessment
Services should be set up to deliver comprehensive geriatric assessment (CGA), in which a multidisciplinary team not only assesses the medical health of the patient, but it also assesses the patient’s mental health, their capacity to carry out daily activities and exercise, their social circumstances and what kind of support they have, and their home environment. A typical multidisciplinary team to deliver CGA would be a geriatrician, nurse specialist, occupational therapist, pharmacist and others as needed, (eg speech and language therapist, dietitian).
The toolkit recommends domains for assessment, models of care and a whole systems approach across primary and secondary care, and health and social care interfaces.
As frailty issues are so common in the AMU, the toolkit suggests a need for a lead clinician to be based there to focus solely on these issues.
Dr Simon Conroy, lead author of the toolkit, said:
The British Geriatrics Society is delighted to support this important initiative to establish the best care for older people in acute medical units. Holistic assessments in the acute medical unit will improve patient outcomes and service efficiency.
Dr Mark Temple, RCP acute care fellow, said:
Older people are more likely to have an emergency medical admission and stay longer in hospital. However the clinical assessment of frail older patients can be difficult. This toolkit is important as it focuses on the assessment of acutely ill older patients and getting this right can have an enormous impact on the quality of care and patient outcomes.
Dr Varo Kirthi, RCP clinical fellow to the president, said:
Following the successful launch of our previous acute care toolkits on Handover and High quality acute care, this third toolkit provides timely guidance to all doctors on caring for older frail patients in the AMU. This latest toolkit contains useful education and descriptions of common ‘frailty syndromes’, which will assist doctors of all grades in providing the comprehensive assessment and treatment these patients require in the AMU.
- The British Geriatrics Society (BGS) is a multi-disciplinary professional membership association that seeks to promote better health and care for older people. It holds scientific meetings, produces clinical guidelines, shares best practice and acts as an ‘expert voice’ on the care of older people and promotes better health in older age. It has over 2,500 members including doctors practicing geriatric medicine, old age psychiatrists, general practitioners, nurses, therapists and scientists. Visit www.bgs.org.uk
- The Royal College of Physicians (RCP) plays a leading role in the delivery of high-quality patient care by setting standards of medical practice and promoting clinical excellence. We provide physicians in the United Kingdom and overseas with education, training and support throughout their careers. As an independent body representing over 27,000 fellows and members worldwide, we advise and work with government, the public, patients and other professions to improve health and healthcare.