Assessment and Management of Older People in the General Hospital Setting

Abstract

Worldwide, populations are ageing. Older people, particularly centurions, represent the fastest growing sector and are counted as the success of the society. But not everyone ages successfully and enjoys good health. Many older people have multiple long-term medical, physical, mental, psychological and social problems. This can result in reduced quality of life, higher cost and poorer health outcome including increased mortality. Chronic diseases are associated with disability and low self-reported general health. In addition, physiological changes of ageing and consequent loss of functional reserve of the organ systems lead to the increased physical disability and dependency. Therefore, geriatric medicine could warrant a more holistic approach than general adult medicine. Nearly two-thirds of people admitted to hospital are over 65 years old and an increasing number are frail or have a diagnosis of dementia [1]. Our current training not only generates relatively low number of geriatricians but there also remains a huge need for better staff training and support to provide safe, holistic and dignified care. The cornerstone of modern geriatric medicine is the comprehensive geriatric assessment (CGA). This is defined as multidimensional, interdisciplinary diagnostic process that aims to determine a frail older person's medical conditions, mental health, functional capability and social circumstances in order to develop a coordinated and integrated plan for treatment, rehabilitation and long-term follow-up [2]. All older people admitted to hospital with an acute medical illness, geriatric syndromes including falls, incontinence, delirium or immobility, unexplained functional dependency or need for rehabilitation warrant CGA. CGA could screen for treatable illnesses, establish the key diagnosis leading to hospital admission and formulate a rational therapeutic plan thus resulting in the improved outcome. This chapter starts with an introduction to the ageing nation and impact of ageing on hospitals. This will be followed by discussing physiological changes of ageing and the various components of multidisciplinary assessment for older people admitted to hospital with an acute illness that could lead to high-level holistic care. It also covers a wide range of issues and challenges which medical team/multidisciplinary teams often come across during routine care of acutely

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