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Royal College of Physicians

Clinical Articles, News & Views

New toolkit for elderly care

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.

The new 6-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), intended to produce better diagnosis, fewer unnecessary admissions, and a reduced need for long-term care.

In addition to communicating effectively with the patient, doctors are also advised to 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.

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, (e.g. 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”.

Published on: May 24, 2012

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