6. Ageing and health care

Question 1

What discoveries are specified in the Royal College of Physicians – Future Hospital Commission for older people and hospital care?

Answer 1

Peoples needs are often complex (so hospital must accomodate all aspects of care needs)

Care, treatment and support services must all be working in collaboration

It is clear that all parts of the health and social care system, and the professionals that populate it, have a crucial role to play in developing and implementing changes that improve patient care and meet the needs of communities

Our hospitals are struggling to cope with the challenge of an ageing population and increasing hospital admissions.

Result? Out most vulnerable patients (old, frail, dementia) are failed by ill-equipped and unwilling system

Question 2

Death rates from particular conditions are affected by two main factors:

Answer 2

• the incidence (new cases) of a condition (eg Myocardial Infarction rates) and
• the survival rates from that condition

Question 3

Trend in health service use?

Answer 3

So our population health is improving (at least in terms of a number of under 75 (premature) mortality rates
but..
• our health services are under more and more pressure, year on year.

Question 4

Prevalence of Chronic Disease/Long term conditions, trend?

Answer 4

The prevalence of many conditions rises with age.(higher incidence due to ageing population and longer survival due to advances in care and treatment)
E.g. The rising prevalence of people living with Dementia – because more people are living longer to ages where dementia occurs more often

Question 5

Implications of global ageing… What does the WHO have to say?

Answer 5

1. Good health is key if older people are to remain independent and to play a part in family and community life.
2. non-communicable and chronic diseases need to be detected and treated early to minimise their consequences. Those who have disease will need decent long term care and support. Primary care in key in service delivery.
3. Public health action can also draw on the capacities of older people.

Question 6

Changes occurring in GP due to ageing population?

Answer 6

Enhanced and extended specialty training in general practice
General practice is facing the dual CHALLENGE of an ageing population with complex, multiple co- morbidities.
The structural changes
-demand much more in terms of clinical, managerial and leadership skills.
-More and more patients will be treated outside of hospital, in their homes and communities

Question 7

The palliative care approach:
Addresses the…
Integration of….
Comprises…

Answer 7

Addresses then…. Physical, psychological, social and spiritual needs of the patient and families

Integral to all clinical practice – whatever the illness or its stage

Comprises – focus on quality of life; whole person approach; takes account of person’s and carers views; respects autonomy and choice; open and sensitive communication

Question 8

Misconceptions about palliative care?

Answer 8

• Palliative Care is not just the province of specialists – it is everyone’s business – Some may use the term Supportive Care.
• Palliative care is not only relevant at the end of life, palliative needs arise throughout an illness trajectory

Question 9

Meeting future health needs of the older population, considerations?

Answer 9

1. Managing and supporting those living this long term conditions
2. Encourage independent living using self care, support from family/carers
3. QoL and independence focus whilst managing disease
4. Holist approach is key
5. Prepare for complex needs
6. Collaboration with other medical disciplines in timely fashion
7. Focus on individual patient specific needs
8. Good balance of specialist and generalist roles and functions

Question 10

Aim of hospital at home model?

Answer 10

To help manage acute medical problems in the home where that is possible.
First patient needs are fully assessed.

Question 11

What is the rationale for “Hospital at home” model?

Answer 11

1. Maintain care arrangements
2. Family and carers are still involved
3. No disorientation from hospital environment
4. Quicker return to function
5. Good links to other community services and social care
6. avoid hospital bed use

Question 12

Main challenge of “hospital at home” model?

Answer 12

needs good clinical and care processes to provide safe hospital care in the home

Question 13

What is realistic medicine?

Answer 13

Realistic Medicine puts the person receiving health and care at the centre of decision-making and creates a personalised approach to their care. It aims to reduce harm, waste and unwarranted variation, all while managing risks and innovating to improve. These concepts will be essential to a well-functioning and sustainable NHS for the future.