1 / 30

Ageing societies: extra years or extra tears? Challenges for 21 st century primary care

Ageing societies: extra years or extra tears? Challenges for 21 st century primary care Louise Robinson Professor of Primary Care and Ageing RCGP Clinical Champion for Dementia. Care of the elderly. Our ageing society Health of oldest old: reality not rhetoric

deon
Download Presentation

Ageing societies: extra years or extra tears? Challenges for 21 st century primary care

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Ageing societies: extra years or extra tears? Challenges for 21st century primary care Louise Robinson Professor of Primary Care and Ageing RCGP Clinical Champion for Dementia

  2. Care of the elderly • Our ageing society • Health of oldest old: reality not rhetoric • Challenges for primary care • New ways of working

  3. Our Ageing Society Oldest old” (>85 years) - fastest growing sector! Worldwide 377 million >85 by 2050 Apocalyptic demography “Frail, vulnerable and high users of care” • Oldest old” - >85 fastest growing sector of population

  4. ' Councils 'will struggle with ageing population’ BBC Feb 2010 Councils will struggle to cope with the financial challenge posed by England's ageing population... The Audit Commission said the £9bn a year social care bill will double by 2026 if current practices continue. Councils needed to look at new and innovative ways to provide services, particularly by embracing technology… It highlighted a number of examples of how "telecare" was being used… to link older people to services

  5. Complexity of ageing

  6. Health of older people Lack of empirical data; >85s excluded Service development = research Primary care research: cohort studies MRC CFAS: 13,000 participants >65 Newcastle 85+ study: 800 >85 • Oldest old” - >85 fastest growing sector of population

  7. UK disability profile MRC Cognitive Function Ageing Study(2000) • 62% require daily formal care • 21% dependent on formal services • Impairment: physical, functional and cognitive • Majority living in community MRC CFAS II Is ageing changing? (2009) 7500 participants; 3 centres (Newcastle)

  8. Newcastle 85+ study Joanna Collerton, Karen Davies, Carol Jagger, Andrew Kingston, John Bond, Martin Eccles, Louise Robinson, Carmen Martin-Ruiz, Thomas von Zglinicki, Oliver James, Tom Kirkwood (PI)

  9. Newcastle 85+ study: Aims • Describe in biological, medical and social terms the health of >85s • What factors are associated with health maintenance >85s? • Describe the functional status of >85s and associated health/social care usage

  10. Newcastle 85+ study: Methods • GP record review • Home assessments with nurse interviewers • Interview (validated questionnaires) • Physical, psychological, social, lifestyle • Health/social care use • Test (bloods, ECG, spirometry, hand grip) • 3 phase data collection over 5 years

  11. Newcastle 85+ study: Methods • GP record review (RR) • Home Assessments (HA): nurse interview • Physical, psychological, social, lifestyle • Health/social care use • Tests (Bloods, ECG, spirometry, hand grip) • Study sample • 851/1453 (58.6%): HA + RR • 188 RR (12.9%): 3 (0.2%) HA

  12. Newcastle 85+: Results • Multi morbidity the norm! • Median count: 5 women; 4 men • 58% Hypertension • 51% Osteoarthritis • 31% Ischaemic heart disease • 20% Stroke/TIA • 16% Chronic chest disease • 12% Moderate/severe cognitive impairment

  13. Undiagnosed disease 1 diagnosed undiagnosed

  14. Geriatric syndromes * Significant gender difference

  15. Newcastle 85+: Results • Self rated health (SRH) • 77% excellent/very good/good • 4% poor • Interval of need • 41% independent: 1976 20% (Bond 1982) • 12% daily help; 8% 24 hour care • Functional ability (Activities of daily living) • 20% no difficulty with 17 ADL • Median 3/17 ADL

  16. Support for those living at home • 66% Family (31% spouse; 35% child) • 25% Social Services • Health care use (in last year) • Primary care: 93% GP contact • Secondary care: 1/3 had OP appointment; low use of A/E; hospital admissions!

  17. Newcastle 85+: Conclusions • Diversity of health (Collerton et al BMJ 2009) • Good SRH and function despite multi-morbidity • Is 85 the new 70? Are this group a healthy elite? (Life expectancy at birth 1921: 61 men, 68 women) • Care in the community by the community

  18. Primary care challenges! • Multi-morbidity and poly-pharmacy • Functional problems but less disability? • Falls; Incontinence; Immobility • Frailty • Carer support (55-85 years) • Increasing social isolation • Risk assessment and management • Assessment of mental capacity: decision making Complexity of care

  19. A GP’s Xmas list………. Dear Santa, My practice manager says that I have been a very good GP. I have 100% in all my QOF targets and have only had 1 patient complaint in the whole year! Please, please, please can I have a geriatrician, a social worker AND a physiotherapist for my practice……. Louise aged x years Ps Don't worry about the gift wrapping !

  20. 21st century primary care • 21st century GP (geriatrician!) • Longer consultations: RCGP 15 mins • Training...fit for purpose? • Commissioning role • Primary care team - ? fit for purpose • Nursing roles: nurse practitioners; chronic disease nurses; community matrons • Voluntary sector: better links? • Integrated health and social care • Community geriatric teams

  21. 21st century geriatric care • Geriatric care: new approaches • Geriatric assessment teams • Medical Crisis in Older People programme • ‘Front door’ assessment and care teams (FACT) • Integrated medical and mental health acute wards • Role of assistive technologies • DoH Demonstrator project: AT and long term conditions • Integrating telecare into LTC care in UK (May et al 2009) • Lack of ownership: failure to translate research – practice • GPs not involved and not keen to been involved!

  22. 21st century community care • Integrated health and social care budgets • Collaborative care model • Case manager: 1’/2’ care link (nurse; social worker • Evidence-based guidelines on common issues • Therapeutic skills: counselling/prescribing • Knowledge of community care services • Evidence base: US studies • Depression (Callahan et al 2005): Dementia (Callahan et al 2006)

  23. Collaborative care model • Vulnerable older people(Counsell et al 2009) • 2 years of home-base care management • Case management: Nurse practitioner and SW • 12 protocols for common geriatric problems • Integrated care: GP/interdisciplinary geriatrics • Improved quality of care/health-related QOL

  24. Conclusions • Services informed by research • New ways of working: NCS not NHS • Integrated, seamless care • Commissioning: combined health and social care budgets • Primary care • 21st century GP/primary care team: training • Primary care and geriatric care

  25. One T shirt we will all wear !

  26. a.l.robinson@ncl.ac.uk

More Related