How Western Medicine is Failing Older People.
Current hospital Emergency Department (ED) practice routinely focuses on fractures or the injury sustained after a fall, while there is little systematic assessment of the underlying cause, functional consequences, and options for future care and falls prevention strategies. Frail older patients are commonly sent home without being “fully sorted”.
Then if the Emergency Department (ED) Doctors try to admit these frail older patients under a “single organ team” when these type of patients have multiple complex medical problems that require multi-disciplinary holistic medical care, they simply do not fit into a “single tick box problem approach”.
So these single organ teams may be reluctant to accept the patient, resulting in multiple phone calls from ED in an attempt to find someone who will accept the patient. The bottom line is that the majority of patients in public hospitals are complex, frail and old! Yet the system is still trying to palm them off to single organ Doctors who do not address their multiple complex medical and psychosocial problems.
The lack of medical care in nursing homes commonly leads to a medical crisis such as falls, delirium, and infections that could be prevented and managed successfully in the nursing home by early intervention.
The bottom line is that there should be much better medical care and after hours medical cover in nursing homes to deal with complex medical issues. My solution is that all Public Hospitals should be attached to local nursing homes and provide 24 hour on call rostered medical care with Junior and Senior Medical Staff doing regular rounds and providing on-site after hours medical reviews as needed.
The worst outcome is a frail older nursing home patient lying on a trolley in ED for hours only to be sent back to the nursing home more confused. So why doesn’t a Cardiologist or other Specialists rather than just Geriatricians visit nursing home patients?
Better medical care in nursing homes would reduce the pressure on Public Hospital Emergency Departments and provide better outcomes for nursing home patients. This would also reduce health care costs for Governments.
Public hospital emergency departments (ER) tend to simply “patch-up’ the patients as quick as possible and get them out! They don’t look at the “big picture”, they don’t look at the underlying multiple chronic medical problems and their impact on the older patient’s general function and quality of life instead of taking the better holistic view of the patient which results in better health outcomes, less hospital re-admissions, and reduced health care costs.
Home visits by Doctors save health care dollars and prevent hospital admissions.
The usual current model of “single organ” (SOD) specialised hospital care for patients, does not focus on functional impairment and early mobility.
Prolonged bed rest of the older patient is commonly associated with significant functional decline even after the initial clinical problems have been treated.
More than 50% of all frail older patients do not recover to their previous functional levels even after 12 months after hospital discharge, causing increased falls risk, higher risk of readmission to hospital and nursing home placement.
Hospitals are increasingly being run by non medical, non clinical people (Managers) making decisions about the medical care of the older patients. This puts the health care of older people at risk and is just unsafe to allow unqualified people to make decisions about and manage someone’s medical treatment.
Too much hospital bureaucracy focuses on ticking useless boxes like teaching staff how to use a fire extinguisher and washing hands rather than looking at the big picture of how to screen for delirium, falls risks, malnutrition, adverse drug reactions, drug to drug interactions, monitoring lying and standing blood pressure, actually weighing the patient, testing memory and cognition.
It is not cost effective to put the majority of health funding for the care of the elderly into the acute hospital-based system when the greatest need is in fact in the community.
By failing to screen and address the needs of high risk Geriatric patients in the community, hospitals are setting themselves up for a “tidal wave” of complex, frail, Geriatric patients presenting to the Emergency Department who could otherwise have been safely and cost effectively managed in the community without the need for an acute hospital presentation.
Home visits by Geriatricians prevent hospital admissions.
Home visits by Doctors are a dying art!
The estimated number of hospital Emergency Department admissions prevented by home visits over 6 months by just one Geriatrician is at least 100, with a 10 day length of stay at least, the cost saving for just one hospital is at least $2 million every 6 months.
Ambulance ramping and queuing of patients in the emergency department (ER) of hospitals could be fixed by Dr Lipski’s “White Paper” and holistic model of medical care.
For more information read Dr Peter Lipski’s book “Your Elderly Parents Failing Health. Is It Ageing Or A Treatable Condition”.