Care of the Elderly - Derby GP Specialty Training Programme

Care of the Elderly
Dr James Betteridge
Speciality Registrar – General Practice
October 2012
The Task and The Plan
Dear James,
If you had been charged with
planning care for the elderly
in Derbyshire, being mindful
that you could have 4
grandparents between age 7585, what essential elements
would you insist on inclusion?
PS You’ve got 30 mins for
your talk and discussion
• Population Statistics
• Requirements for
elderly care and the
logistical and
financial challenges
they bring
• Examples illustrating
the need for “Joined Up
• My vision…..
• Discussion
The Facts
• By 2035 the population of Derby
City and County will have increased
by 18.6% to 1.2million
• By this time there will be 53% more
people aged 65+ living in Derby
City and 73.6% more people aged
65+ living in the County of
• More worryingly, in 2035 I will be
Source: Derbyshire County Council
• Primary Care
– GP including District Nursing Provision
– Therapeutics – OT, Physio, Audiology
• Secondary Care
– Planned
– Unplanned
• Social Care
– Support at home
– Residential/ Nursing Care
Primary Care
• An estimated 4 million (36% of people aged 6574 and 47% of those aged 75+) have a limiting
longstanding illness.
• 16% of older people (65+) surveyed said they
had experienced some difficulty in making a
GP appointment
• The percentage of consultations undertaken as
home visits fell from 22% in 1971 to 4% in 2006
• Older people are more likely than other age
groups to receive a home visit by a GP. In 2006,
15% of GP consultations for people aged 75
and over were undertaken as home visits
• Every hour, over 50 older people are neglected
or abused in their own homes by family
members, friends, neighbours or care workers
Secondary Care
• Nearly one in five (19%) find it very difficult to get
to their local hospital
• The number of emergency readmission for people
aged 75+ in English hospitals in 2009/10 was
188,138, a rise of 88% since 1999/2000 86
• Each hospital bed costs on average £260 a day
• Up to 60% of older people in hospital have mental
health problems or develop them during their stay
• Up to 25% of all hospital beds are occupied with
older patients with dementia and they stay in
hospital for longer than others with similar
• In 2008, 32% of people aged 65 and over who were
admitted to hospital were found to be
malnourished at the time of admission
Social Care
• In England, 453,000 people received home care
services in 2009
• About 410,000 older people in the UK have an
unmet need for help with practical household
• There are approximately 420,000 elderly and
disabled people in residential care (including
• The residential care market is estimated to be
£14 billion, of which the private (for-profit)
sector is worth £9.9 billion
• The UK average annual fee for a single room in a
private residential home is £26,104 (£502 per
week). For a nursing home, it is £36,296 (£698
per week)
Joined Up Thinking #1 - Falls
• About a third of all people aged over 65 fall
each year (which is equivalent to over 3
• Hip fractures are the most expensive
osteoporosis fracture with estimated costs per
patient of £28,000
• Falls account for 10 – 25% of ambulance allouts for people aged 65+, costing £115 per
• The combined cost of hospitalisation and social
care for hip fractures (most of which are due to
falls) is £2 billion a year or £6 million a day
• Half of those with hip fracture never regain
their former level of function and one in five
dies within three months
• A falls prevention strategy could reduce the
number of falls by 15 – 30%
Joined Up Thinking #2 - Loneliness
• Half of all people aged 75 and over live
• Half of all older people (about 5 million)
consider the television as their main form
of company
• 12% of over 65s said they never spent time
with their family
• 17% of older people have less than weekly
contact with family, friends and
neighbours, 11% have less than monthly
• People who took part in more healthmaintaining and independencemaintaining behaviours were less likely to
feel isolated and more likely to feel that
their community was a good one to grow
old in.
Betteridge Reforms 2012
• Elderly patients need to be actively identified by their GP
• Opportunistic monitoring and health promotion should be
undertaken alongside management of acute illness,
including assessment of mental health and monitoring for
• Chronic illness should be monitored regularly and,
increasingly, in a primary care setting to improve ease of
access. This may well be by a non-doctor HCP
• “Virtual Wards” could be used by GP practices to aide
transition of patients between primary and secondary care
• GPs should have increased access to community based
rehabilitation beds to provide therapeutic input for
patients that are currently admitted for “Social Sort Outs”
Betteridge Reforms 2012
• Secondary Care should aim to offer more outpatient
appointments in a primary care location to improve access
and DNA rates
• A hand held personal care document +/- online equivalent
could be made available for patients to ease transition
between services and reduce errors
• NHS organizations should actively promote and encourage
schemes provided by voluntary/ not for profit organisation
to help the elderly
• All healthcare professionals to receive increased and better
training regarding care of patients with Dementia
• There needs to be a gear shift with regards to earlier
discussion of end of life care and planning

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