20 * A PROACTIVE OUTREACH GERIATRIC ASSESSMENT SERVICE FOR OLDER HOSPITAL PATIENTS OUTSIDE ELDERLY CARE WARDS

Abstract

Background:Patients in general hospitals are increasingly old, many of them with frailty, dementia, complex co-morbidities and a need for skilled discharge planning and rehabilitation. Comprehensive Geriatric Assessment led by geriatricians on a specialist home ward improves outcomes for frail, older patients but many such patients “outly”. We piloted a Proactive Liaison service to non-geriatric medicine wards in a district general hospital to describe gains for recognition and management of geriatric syndromes, improved processes and outcomes. Method:We provided the pilot service for three months in 2013 on three medical wards with an older case mix. A consultant geriatrician or specialist registrar proactively reviewed all patients over 65, liaising with the ward multidisciplinary team. We collected data prospectively from direct patient assessment, medical notes and computer records. We documented patient characteristics, medical issues, interventions and outcomes. Evaluation:We assessed 140 patients (81 F, 59 M), median age 85 (range 66–97). We excluded 26 patients due to insufficient data. Issues we identified included; delirium (35% of patients), a new diagnosis by our team (29%), falls (23%), unmet social needs (21%), pain (13%) and immobility (13%). Our most common interventions included referral to other services including older persons mental health liaison or palliative care (30%), medications cessation (20%), focused investigations e.g. for delirium (19%) and decision-making around discharge (18%).We transferred 8% of patients to geriatric medicine “home” wards. 44% of patients were discharged home. Mortality during the patient hospital admission was 11%. Conclusion:Even where geriatricians are “on take” for needs related geriatric medicine 7 days a week, providing a proactive in reach service to non-geriatric medical wards, rather than waiting for referrals, helped identify a range of problems related to frailty, dementia, delirium co-morbidity or discharge planning and value add to existing ward care.