NEWS
Outcome and Death looks at elderly patients who died in hospital within 30 days of undergoing surgery. Only one-third were judged to have received good care. NCEPOD is calling for specialist elderly care and consultant input at all stages of the patient pathway.
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Report author and NCEPOD clinical co-ordinator in surgery Mr Ian Martin expressed concern that the report had revealed such major fl aws in the care of elderly surgical patients. He explained that specialist elderly care teams reviewed less than one third of patients (225/965) before surgery.
“Most patients were admitted as emergencies by very junior doctors without timely input of senior care of the elderly clinicians. There is still a long way to go to ensure good practice and appropriate care – this is despite our advice in 1999 and recommendations in the 2001 National Service Framework calling for specialists to be involved at every stage of elderly care.”
NCEPOD advisors also found little evidence of a well-resourced acute pain service, which they consider essential for modern secondary health care. Report author and NCEPOD clinical co-ordinator in anaesthesia Dr Kathy Wilkinson said that advisors found 71 hospitals that appeared to have no acute pain service: “Pain is not being treated as a fi fth vital sign or being monitored, let alone addressed and controlled. It is shocking that the survey has revealed organisational failures to respond
Nov/Dec 10
he latest study from the National Confi dential Enquiry into Patient
to the suffering of elderly patients. I hope our report is a wake-up call.”
Professor Mike Gough, report author and NCEPOD clinical co-ordinator in surgery said that greater vigilance was required when elderly patients attend the emergency department with non- specifi c abdominal symptoms such as diarrhoea and vomiting, or signs of infection:
“These patients should be assessed by a doctor with suffi cient experience and training. If these patients do not receive appropriate multidisciplinary care, including assessment by a surgeon, their underlying needs may not be appreciated and this is often associated with greater delays in performing surgery.”
NCEPOD chairman Mr Bertie Leigh said that the report made depressing reading: “Our report describes problems that are going to become more and more prevalent. The numbers of people aged over 85 will double in the next ten years, and we must rise to the challenge that this presents.
“Elderly people tend to be more vulnerable than younger patients, and require a style of medicine that is sensitive to their many and varied needs. But, our advisors found that far too many people were not getting that pattern of care. Again and again, I read of cases where doctors were insuffi ciently trained to understand the subtle and complex needs presented by elderly patients.”
Michelle Mitchell, charity director at Age UK, said: “This report is a stark reminder that
far too often older people in the UK receive second or even third rate care in hospital, condemning many of them to an early death.
“Despite the over 65s being the largest cohort of NHS patients, clearly our healthcare system is failing to meet the needs of an ageing population and this situation is only set to deteriorate further as life expectancy continues to increase.
“Yet this comes as no surprise considering services which benefi t the over 65s are often under-funded and seemingly a low priority for commissioners. Healthcare professionals are also increasingly expected to specialise in certain areas of care, often poorly equipping them to deal with the many older people living with multiple conditions and frailty.
“It is very disappointing to see malnutrition continues to cast a dark shadow over the care of older people in hospital. Through the ‘Hungry to Be Heard’ campaign, Age UK has raised the issue of poor nutritional standards for older people in our hospitals time and again, yet progress on this relatively straightforward problem remains stubbornly static.
“Ageist attitudes cannot be allowed to distort the standard of care people in later life receive. Age UK is calling for a whole system review of the impact of ageing on the NHS, including the need to equip the workforce with the skills to deliver effective care for older people. Inevitably, the majority of us rely on the NHS more at the beginning and later stages of our lives and it is vital the system refl ects this need.
Key fi ndings
· Just over 1/3 of patients surveyed (38%, 295/786) received good care.
· Poor nutrition and serious associated illness were very common in the group we studied.
· In over two-thirds of cases (67.7%, 653/965), patients were not reviewed by specialists in medicine for the care of older people.
· Clinically signifi cant delays occurred in 1 in 5 patients between admission and their operation.
· 1/4 of hospitals had no acute pain service.
Key recommendations
· In elderly patients needing urgent surgery careful attention should be given to improving fl uid status, reducing unnecessary drug treatment and anticipating nutritional support.
· Elderly patients undergoing surgery need access to routine daily clinical review from specialists in elderly care.
· Delays in surgery, which lead to poor outcome, should be subject to rigorous audit and rectifi ed.
· Pain and its management should have a high priority to avoid patient suffering.
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