Admission Prevention: A developing specialism in older peoples care
With an aging population that is set to double in the next 30 years, we look at the services being developed to keep older people in the best of health and out of hospital.
24th April 2017
BY RUTH UNDERDOWN
‘There are now 11.6 million people aged 65 or over in the UK’
‘There are 14,570 centenarians in the UK, a 65% increase over the last decade. Of these, an estimated 800 are aged 105 and over, double that of 2005’
‘The number of people aged 65+ is projected to rise by over 40 per cent (40.77%) in the next 17 years to over 16 million.’
Older people’s care has been of increasing concern over recent years for both the NHS and social care services. The older population is growing quickly and their health needs are more complex as medicine advances. Being able to provide adequate safe and compassionate care has been limited by the financial constraints of service provision and the growing needs of service users. This is leading to new and innovative approaches in a bid to prevent unnecessary hospital admissions and prolonged hospital stays.
‘One in four hospital inpatients have dementia, and 1 in 3 adults admitted acutely to hospital are in the last year of their life. The care of older people in acute settings continues to be a priority area, with most Trusts/LHBs facing pressures from increased A&E attendances at the front door of the hospital and delayed transfers of care at the back end.’
Specialist older people’s nurses are being increasingly recruited to support and develop services to help avoid prolonged hospital admissions. Acute trusts are employing them to work out of emergency departments and assessment units, whilst community trusts are developing teams to actively support management of falls and acute illness at home. It is a growing trend in service development but currently there is limited evidence into the effectiveness of such schemes.
With this in mind, many NHS trusts have taken to developing models of care designed to reduce length of stay and to divert older people from the acute trusts before they are referred, diverting them to community led admission avoidance services wherever possible. Multidisciplinary teams, headed by geratologists can be based out of the emergency department and community hospitals and, with the help of a skilled team of nurses, therapists and social workers, create a holistic care strategy to support the management of the patient at home, thereby preventing a lengthy admission to hospital.
The skills required for nurses involved in these services are wide and varied. Being able to walk into a patient’s home and not only assess the potentially acute medical need, but also the social needs of the person and the family, requires strong interpersonal skills. But it is hugely rewarding. Being able to keep someone at home who does not want to go into hospital is clearly a benefit. But being able to provide many of the services that they would receive in the acute setting is key to the success of these services.
And a lot of older people do not want to go into hospital. Hospitals are scary, noisy places at the best of times. For those who are frail, vulnerable and often have cognitive impairment, the possibility of going into an unfamiliar environment is not a welcome thought.
It is widely accepted that functional ability, risk of infection, and cognitive decline are all related to prolonged hospital admissions. Therefore, keeping people out of hospital serves more than just the NHS but actually prevents deterioration in quality of life.
A much larger study is currently being undertaken by the University of Oxford to quantify the risk and benefit attached to older people being admitted to hospital compared to being cared for at home.
Keeping people in hospital is costly, and people over 85 account for a quarter of all bed days in the NHS. Avoiding this would be better for older people, reduce admission to residential care and keep people living at home longer, and also save money
If the evidence is proven, then there will undoubtedly be an increase in the development of these services and a new specialism will emerge, further moving acute care away from the hospital environment. Saving money but more importantly, improving quality of life for our older generation.
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