Location: Dinwoodie Lecture Theatre, Cicely Saunders Institute, Denmark Hill Campus
Diagnoses, problems and healthcare interventions amongst frail older people admitted to hospital as an emergency
Speaker: Professor Rowan Harwood
About the speaker: Rowan is a consultant geriatrician who maintains an active role in research and teaching. Appointed as a consultant in 1996 and honorary professor at the University of Nottingham in 2006, he has wide clinical and research interests, including delirium, dementia, stroke, continence, rehabilitation, end-of-life care, falls and clinical ethics. In 2009, following 10 years in stroke medicine, he embarked on a programme to develop and evaluate better ways to manage cognitively-impaired older people in general hospitals and other dementia-related research. He has written four books on stroke and dementia and 80 academic papers.
Abstract: Popular and professional images of the function of the acute hospital focus on diagnosis and treatment with curative intent. The predominant users of acute medical services are frail older people. It was found that 1 in 3 people who had emergency hospital admissions had delirium or dementia; they also had multiple co-morbidities and a high prevalence of both physical disability and psychopathology. Outcomes were poor, with a third dying and a quarter moving to care homes within 6 months. A specialist medical and mental health unit was developed to care for these patients more appropriately and this was evaluated in a randomised controlled trial. Hard measures of health status and resource use were marginally better for patients on the specialist wards, but measures of patient experience and family carer satisfaction were substantially improved. Care for frail older people in hospital is eclectic: elements of acute, rehabilitation and end-of-life care are needed. Proper consideration must to be given to family carers and the needs of other stakeholders such as care homes. Best practice care for this patient group may be framed best within a palliative care approach.
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