Comprehensive geriatric assessment may increase the likelihood that frail older people can be discharged to independent living | Cochrane Database of Systematic Reviews | via National Institute for Health Research
Older people who received comprehensive geriatric assessment when in hospital were slightly more likely to be living in their own homes one year later. Sixty percent were discharged to independent living compared with 56% receiving standard ward care. People who had received this proper assessment were also 20% less likely to be in a nursing home after three months or more.
Comprehensive geriatric assessment is a careful review by a multidisciplinary specialist team of people’s medical, functional, mental and social capabilities. It aims to improve recovery and enable people to maintain function and independence.
This updated Cochrane review covered 29 trials compares this assessment with routine care for people over 65, excluding those with stroke and orthopaedic conditions. It may save NHS resources, but the quality of evidence was too low to assess this reliably.
Hazra N C, Rudisill C, Gulliford M C. Determinants of health care costs in the senior elderly: age, comorbidity, impairment, or proximity to death? Eur J Health Econ. 2017. [Epub ahead of print].
Ageing on its own does not drive healthcare costs. Instead, this research found that the increasing number of health conditions and age-related impairments along with the proximity to death are more strongly linked to healthcare costs than age alone.
This UK study investigated healthcare costs in people over 80 years old. Costs increased to the mid-90s before declining again. Proximity to death was the strongest predictor of cost, which was higher for people aged 80-84: £10,027 per year versus £7,021 per year for those over 100. Multiple illnesses also had a strong influence, with each additional health complaint progressively increasing costs.
This suggests that to provide person-centred and efficient healthcare services for all, planning should take account of the number and types of conditions rather than age alone.
National Institute for Health Research (NIHR) Themed Review: Advancing Care: Research with care homes
There are more than twice as many people living in care homes in England and Wales, than there are people staying in hospital. Yet we know far more about effective treatments in hospital and less about what works most effectively to improve care for older people in care homes. Research in care homes is a relatively new and emerging field.
Advancing Care provides an overview of recent NIHR research on improving the health and care of care home residents. It highlights current research taking place now and explores new approaches being developed in this important area.
The reviewbrings together NIHR research on three themes relating to the care of older people in care homes: Living well – maintaining good health and quality of life, ageing well – managing long term conditions associated with ageing, and dying well – ensuring a good quality end of life. It features:
23 published studies
21 ongoing studies
Quotes from care home owners, managers, staff and researchers
National Audit Office has published findings of investigation into NHS continuing healthcare.
NHS continuing healthcare (CHC) is a package of care provided outside of hospital that is arranged and funded solely by the NHS for individuals who have significant ongoing health care needs. Funding for ongoing health care is a complex and highly sensitive area, which can affect some of the most vulnerable people in society and those that care for them. The number of people assessed as eligible for CHC funding has been growing by an average of 6.4% a year over the last four years. In 2015-16, almost 160,000 people received, or were assessed as eligible for, CHC funding in the year, at a cost of £3.1 billion.
This report from the NHS Partners Network highlights examples where the independent sector is working with the NHS to avoid delayed discharges of care. Reducing delayed discharge – where often frail and elderly patients are unable to leave hospital due to necessary care, support or accommodation in the community being unavailable – is arguably one of the biggest priorities for the NHS.
Delayed discharges and transfers of care (DTOCs) have a significant impact on the ability of NHS acute trusts to provide routine treatment such as elective surgery. It is vital, both for the patient and the trust, to be able to discharge patients speedily to avoid adverse effects to patient flow.
This updated document summarises guidance and evidence for managing frailty. It is based on national guidance and existing sources of synthesised and quality-assessed evidence | University of York Centre for Health Economics | Yorkshire and Humber AHSN Improvement Academy
Frailty is a distinct health state where a minor event can trigger major changes in health from which the patient may fail to return to their previous level of health.
Simple tests that have been recommended by NICE for frailty in primary care are gait speed, self-reported health status and the PRISMA 7 questionnaire.
Exercise programmes, particularly high intensity interventions, may improve gait, balance and strength and have positive effects on fitness.
Medication review forms part of the holistic medical review of people with frailty.
Supported self-management can improve health outcomes. However, the value of case management is still to be proven.
Discussion about end-of-life care is important to most older people, but is often neglected.
The projects are using new and interesting approaches to improve care for older people and include people managing their own risk of getting a pressure ulcer; remote assessment using smart glasses; extending primary care teams; and continence promotion in care homes.