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?

Jim 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 Thinking” • 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 Derbyshire • More worryingly, in 2035 I will be 51! Source: Derbyshire County Council

Requirements • 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 conditions • 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 jobs • There are approximately 420,000 elderly and disabled people in residential care (including nursing) • 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 million) • 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 callout. • 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 alone • 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 contact • 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 practices • Opportunistic monitoring and health promotion should be undertaken alongside management of acute illness, including assessment of mental health and monitoring for abuse. • 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 services • 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