Speciality Registrar – General Practice 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 75-85, 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 Secondary Care Social 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 65-74 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 36% of older men and 39% of older women have normal, untreated blood pressure (compared with 80% and 84% of aged 19-64). Only 21% of older men and 23% of older women have controlled hypertension; the rest are uncontrolled or untreated.

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 all-outs 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 health-maintaining and independence-maintaining 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