Transcript Health Professional

Aging and Health
Fairness Commission
Marianne Plater
Community Geriatrician
Functional decline
Transitional
phase
Frailty
EOL
Time
?
Social
Friends
Services
&
Family
GP
Hospital –
(last year of
Life)
Ageism
Society
Health Professionals / System
Own belief structures– ‘oh its just my age’
Evidence of Ageism in Health Care
Ageism and age discrimination in primary and community health
care in the United Kingdom
A review from the literature
commissioned by the
Department of Health
carried out by the
Centre for Policy on Ageing
Summary
● Strong evidence of unmet need and
difficulties accessing GPs
● Less life style advice in the older patient e.g. alcohol / exercise
● Lower rates of investigation / treatment / secondary prevention of cancers, heart
disease and stroke
● Disability living allowance (based on age)
● Allow for a mobility component and is thus not available to older people
● Medical Trials often exclude or have difficulty in recruiting the
over 65s let alone the over 80s
● ?QALY quality of adjusted life years – used by NICE
Why so much Ageism?
● Individual Perspective
● Health Professional
● Systems
Individual
● People expect / accept functional decline
● Fear and Anxiety
● Cognitive rigidity as a feature of Ageing
brain
● Mobility issues –
● Stop driving
● Decrease in stamina / balance
● Financial
● Social Isolation
Maslow’s Hierarchy of Need (1943)
Health Professional
● GPs reduced number of home visits from 22% in 1971 to
4% 2006
● Lack of Geriatric training especially around Frailty / Falls
● Decline in Dr / Pt communication and continuity of care
since the Quality Framework was introduced
● DNA policy for secondary care
● Increasing number of readmissions from Hospital
● Low rate of referrals to secondary care
● Shift towards single organ specialists – less holistic
Current Systems
● Require individuals to be:
● Proactive + articulate
● Mobile
● Persistent
What does work?
Comprehensive Geriatric Assessment
‘A multidimensional, interdisciplinary diagnostic process
focused on determining a frail older person’s medical,
psychological and functional capability in order to
develop a co-ordinated and integrated plan for treatment
and long term follow up.’
British Geriatric Society
Key Areas
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Early identification
Longitudinal Management
Diagnosing End of Life
Proactive Management
Early Identification - Iceberg
AMU, ED, OOH, GP, DN’s, SS, etc
Falls /  Function / UTI
Cognitive Impairment
•Poor personal care
•Weight loss (intake)
•Poor drug concordance
•Un-insightful – refuses POC
•Poor response to rehab
Southampton Community Services
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GP meetings – monthly to
» Case finding – formal – DES (ACG tool ?) Urgent Care Dashboard
- informal eg receptionist
» Case discussions - re on going management
- feedback
Rehab Team meetings – weekly
Matrons (advanced practitioners) band 7s –
• individual support – by phone – daily if required
- weekly supervision + weekly V/W
• System / process development – weekly
Team links with inpatient consultants
» Doctors work list
» Phone calls
» MDT meetings
Social work team
» Virtual ward
» Senior Practitioner / Team Manager
» Individual case holders
Opportunistic e.g. respiratory team
Staff Relationship Building
Attitudes + Beliefs
Individual experience
Case by case feedback
- case reviews
- mortality reviews
- clinical supervision
- clinical management
Motivational Interviewing
Psychologist
Knowledge and Understanding
Traditional training very
limited for large groups of
health and social care
workers
Limited success in
changing practice
To Build on this.....
● Re integrate with Social Service
● Successful Aging
● Exercise
● Mid life weight
● Social integration
● Carer training
● Specialist Knowledge in the community
● Professional identity issues
● Number of Geriatricians has fallen by 1.6% compared
with increase of 85% stroke or 23% acute physicians