Care of Older Adults RCGP Curriculum Statement 9 Susan Drysdale & Paul Milnes, Consultants in Medicine for the Elderly Robin Poulier, GP in Ilkley 11 th January 2011 Airedale VTS

Key Messages UK has an ageing population Increasing proportion of a GP’s workload which has an important role in the delivery of improving care to older people Co-morbidity, communication difficulties, poly pharmacy and additional support are the important issues that pertain to this group

Key Facts In the last 70 years alone, the number of people aged over 65 has doubled 20% of the population is over 60 Over 30 years from 1995, the number of those aged over 80, will rise by 50% Similarly, the number of those aged over 90, will rise by 100% Those over 65 (15%), account for 40% of spending in health and social care

NSF for Older people Age discrimination Person-centred approach Intermediate care General hospital care Stroke Falls Mental health in older people Promotion of health & active life

What should we learn, and what should we remember? Primary Care Management Person-centred care Specific Problem-solving skills A comprehensive approach Community orientation A holistic approach

Primary care management Manage primary contact with older patient Skills in therapeutics, medication reviews Coordinate care Knowledge of how to access services Communication skills, screening programmes Act as an advocate – MHA, living wills etc.

Person-centred care Prognosis and provision of appropriate plan Respect patient’s autonomy Act in partnership Long term continuity of care

Specific Problem-solving skills Problem based approach –not disease based Clinical reasoning and decision rules Appropriate management plan in collaboration with patient and if appropriate, carer & family Diagnostics – ‘normal’ values

A comprehensive approach Deal with multiple complaints/pathologies Apply health promotion and disease prevention – DVLA regs. Juggle between – health promotion, prevention, cure, care, rehabilitation and palliation

Community orientation Health needs of individual patients Health needs of the community in which they live Balancing act – how can the health care system be used by patient and doctor?

Holistic approach Patient’s experiences, beliefs, values and expectations may affect the delivery of healthcare The holistic view acknowledges an objective explanation of physiology but admits that people have inner experiences that are subjective