What is the case for care home medicine: The …...What is the case for care home medicine: The...
Transcript of What is the case for care home medicine: The …...What is the case for care home medicine: The...
![Page 1: What is the case for care home medicine: The …...What is the case for care home medicine: The geriatrician’s perspective Dr Adam Gordon Consultant and Honorary Associate Professor](https://reader030.fdocuments.in/reader030/viewer/2022040523/5e876025635437133370fc36/html5/thumbnails/1.jpg)
What is the case for care home medicine:
The geriatrician’s perspective
Dr Adam Gordon Consultant and Honorary Associate Professor
Nottingham University Hospitals NHS Trust
Email: [email protected]
adamgordon1978
![Page 2: What is the case for care home medicine: The …...What is the case for care home medicine: The geriatrician’s perspective Dr Adam Gordon Consultant and Honorary Associate Professor](https://reader030.fdocuments.in/reader030/viewer/2022040523/5e876025635437133370fc36/html5/thumbnails/2.jpg)
HEALTH WARNING:
Generalizable concepts will be presented.
They will sometimes be viewed through
an English prism.
![Page 3: What is the case for care home medicine: The …...What is the case for care home medicine: The geriatrician’s perspective Dr Adam Gordon Consultant and Honorary Associate Professor](https://reader030.fdocuments.in/reader030/viewer/2022040523/5e876025635437133370fc36/html5/thumbnails/3.jpg)
Care Homes
• Who lives in them?
• What do they need?
• How is care currently provided and does it meet their needs?
• Challenges unique to the care home setting.
• Some ways forward.
![Page 4: What is the case for care home medicine: The …...What is the case for care home medicine: The geriatrician’s perspective Dr Adam Gordon Consultant and Honorary Associate Professor](https://reader030.fdocuments.in/reader030/viewer/2022040523/5e876025635437133370fc36/html5/thumbnails/4.jpg)
![Page 5: What is the case for care home medicine: The …...What is the case for care home medicine: The geriatrician’s perspective Dr Adam Gordon Consultant and Honorary Associate Professor](https://reader030.fdocuments.in/reader030/viewer/2022040523/5e876025635437133370fc36/html5/thumbnails/5.jpg)
In the Care Home Outcome study….
The proportion of care home residents with cognitive impairment was:
• 0-25%
• 26-50%
• 51-75%
• 76-100%
![Page 6: What is the case for care home medicine: The …...What is the case for care home medicine: The geriatrician’s perspective Dr Adam Gordon Consultant and Honorary Associate Professor](https://reader030.fdocuments.in/reader030/viewer/2022040523/5e876025635437133370fc36/html5/thumbnails/6.jpg)
In the Care Home Outcome study….
The proportion of care home residents with urinary incontinence was:
• 0-25%
• 26-50%
• 51-75%
• 76-100%
![Page 7: What is the case for care home medicine: The …...What is the case for care home medicine: The geriatrician’s perspective Dr Adam Gordon Consultant and Honorary Associate Professor](https://reader030.fdocuments.in/reader030/viewer/2022040523/5e876025635437133370fc36/html5/thumbnails/7.jpg)
In the Care Home Outcome study….
The proportion of care home residents who were bed- or chair-bound was:
• 0-25%
• 26-50%
• 51-75%
• 76-100%
![Page 8: What is the case for care home medicine: The …...What is the case for care home medicine: The geriatrician’s perspective Dr Adam Gordon Consultant and Honorary Associate Professor](https://reader030.fdocuments.in/reader030/viewer/2022040523/5e876025635437133370fc36/html5/thumbnails/8.jpg)
Some other headline figures….
• Average number of diagnoses – 6.2
• Median number of medications – 8
• 2/3 had some form of behavioural symptom
• 30% malnourished • 56% at risk of malnutrition
• Average life expectancy
– 1 year for nursing homes – 2 years for residential homes
![Page 9: What is the case for care home medicine: The …...What is the case for care home medicine: The geriatrician’s perspective Dr Adam Gordon Consultant and Honorary Associate Professor](https://reader030.fdocuments.in/reader030/viewer/2022040523/5e876025635437133370fc36/html5/thumbnails/9.jpg)
Effective healthcare responses will….
• Have expertise in management of:
– Multiple diagnoses
– Immobility
– Incontinence
– Challenging behaviour
– Polypharmacy
– Malnutrition
– End-of-life care
![Page 10: What is the case for care home medicine: The …...What is the case for care home medicine: The geriatrician’s perspective Dr Adam Gordon Consultant and Honorary Associate Professor](https://reader030.fdocuments.in/reader030/viewer/2022040523/5e876025635437133370fc36/html5/thumbnails/10.jpg)
![Page 11: What is the case for care home medicine: The …...What is the case for care home medicine: The geriatrician’s perspective Dr Adam Gordon Consultant and Honorary Associate Professor](https://reader030.fdocuments.in/reader030/viewer/2022040523/5e876025635437133370fc36/html5/thumbnails/11.jpg)
Physical
Mental/Psychological
Functional
Social
Environmental
CGA
![Page 12: What is the case for care home medicine: The …...What is the case for care home medicine: The geriatrician’s perspective Dr Adam Gordon Consultant and Honorary Associate Professor](https://reader030.fdocuments.in/reader030/viewer/2022040523/5e876025635437133370fc36/html5/thumbnails/12.jpg)
Assessment
Stratified problem list
Bespoke Management
Plan
Goals
![Page 13: What is the case for care home medicine: The …...What is the case for care home medicine: The geriatrician’s perspective Dr Adam Gordon Consultant and Honorary Associate Professor](https://reader030.fdocuments.in/reader030/viewer/2022040523/5e876025635437133370fc36/html5/thumbnails/13.jpg)
![Page 14: What is the case for care home medicine: The …...What is the case for care home medicine: The geriatrician’s perspective Dr Adam Gordon Consultant and Honorary Associate Professor](https://reader030.fdocuments.in/reader030/viewer/2022040523/5e876025635437133370fc36/html5/thumbnails/14.jpg)
What currently happens
GP’s deliver care as part of GMS….although
sometimes they don’t(!)
GP:care home ratios vary 1:1-1:50
Reactive care models predominate
Multidisciplinary team access is limited
Roles and responsibilities aren’t clearly specified
![Page 15: What is the case for care home medicine: The …...What is the case for care home medicine: The geriatrician’s perspective Dr Adam Gordon Consultant and Honorary Associate Professor](https://reader030.fdocuments.in/reader030/viewer/2022040523/5e876025635437133370fc36/html5/thumbnails/15.jpg)
![Page 16: What is the case for care home medicine: The …...What is the case for care home medicine: The geriatrician’s perspective Dr Adam Gordon Consultant and Honorary Associate Professor](https://reader030.fdocuments.in/reader030/viewer/2022040523/5e876025635437133370fc36/html5/thumbnails/16.jpg)
Common problems
Older people are very complicated.
Trajectories are difficult to predict.
Don’t have the training.
Resources are tight.
Regulation is always present.
Roles and responsibilities aren’t clear.
Communication is a problem.
![Page 17: What is the case for care home medicine: The …...What is the case for care home medicine: The geriatrician’s perspective Dr Adam Gordon Consultant and Honorary Associate Professor](https://reader030.fdocuments.in/reader030/viewer/2022040523/5e876025635437133370fc36/html5/thumbnails/17.jpg)
![Page 18: What is the case for care home medicine: The …...What is the case for care home medicine: The geriatrician’s perspective Dr Adam Gordon Consultant and Honorary Associate Professor](https://reader030.fdocuments.in/reader030/viewer/2022040523/5e876025635437133370fc36/html5/thumbnails/18.jpg)
Solutions have focused around…
Remuneration – carrot.
Regulation – stick.
Parachuting in troops.
Generating social movements.
![Page 19: What is the case for care home medicine: The …...What is the case for care home medicine: The geriatrician’s perspective Dr Adam Gordon Consultant and Honorary Associate Professor](https://reader030.fdocuments.in/reader030/viewer/2022040523/5e876025635437133370fc36/html5/thumbnails/19.jpg)
Be careful what you wish for….
1:1 relationship
Trusting relationship with mutual respect
“I wouldn’t wish our GP/care home on my worst enemy”
![Page 20: What is the case for care home medicine: The …...What is the case for care home medicine: The geriatrician’s perspective Dr Adam Gordon Consultant and Honorary Associate Professor](https://reader030.fdocuments.in/reader030/viewer/2022040523/5e876025635437133370fc36/html5/thumbnails/20.jpg)
Similar issues face
Open ended “social movement” models.
Incentivisation with accountability (too much
carrot not enough stick).
Expertise without appropriate linkages.
Inadequate remuneration (too much stick, not
enough carrot).
![Page 21: What is the case for care home medicine: The …...What is the case for care home medicine: The geriatrician’s perspective Dr Adam Gordon Consultant and Honorary Associate Professor](https://reader030.fdocuments.in/reader030/viewer/2022040523/5e876025635437133370fc36/html5/thumbnails/21.jpg)
Physical
Mental/Psychological
Functional
Social
Environmental
CGA
![Page 22: What is the case for care home medicine: The …...What is the case for care home medicine: The geriatrician’s perspective Dr Adam Gordon Consultant and Honorary Associate Professor](https://reader030.fdocuments.in/reader030/viewer/2022040523/5e876025635437133370fc36/html5/thumbnails/22.jpg)
Assessment
Stratified problem list
Bespoke Management
Plan
Goals
![Page 23: What is the case for care home medicine: The …...What is the case for care home medicine: The geriatrician’s perspective Dr Adam Gordon Consultant and Honorary Associate Professor](https://reader030.fdocuments.in/reader030/viewer/2022040523/5e876025635437133370fc36/html5/thumbnails/23.jpg)
![Page 24: What is the case for care home medicine: The …...What is the case for care home medicine: The geriatrician’s perspective Dr Adam Gordon Consultant and Honorary Associate Professor](https://reader030.fdocuments.in/reader030/viewer/2022040523/5e876025635437133370fc36/html5/thumbnails/24.jpg)
![Page 25: What is the case for care home medicine: The …...What is the case for care home medicine: The geriatrician’s perspective Dr Adam Gordon Consultant and Honorary Associate Professor](https://reader030.fdocuments.in/reader030/viewer/2022040523/5e876025635437133370fc36/html5/thumbnails/25.jpg)
![Page 26: What is the case for care home medicine: The …...What is the case for care home medicine: The geriatrician’s perspective Dr Adam Gordon Consultant and Honorary Associate Professor](https://reader030.fdocuments.in/reader030/viewer/2022040523/5e876025635437133370fc36/html5/thumbnails/26.jpg)
![Page 27: What is the case for care home medicine: The …...What is the case for care home medicine: The geriatrician’s perspective Dr Adam Gordon Consultant and Honorary Associate Professor](https://reader030.fdocuments.in/reader030/viewer/2022040523/5e876025635437133370fc36/html5/thumbnails/27.jpg)
![Page 28: What is the case for care home medicine: The …...What is the case for care home medicine: The geriatrician’s perspective Dr Adam Gordon Consultant and Honorary Associate Professor](https://reader030.fdocuments.in/reader030/viewer/2022040523/5e876025635437133370fc36/html5/thumbnails/28.jpg)
Care Homes
• Present some particular challenges.
• Which demand particular solutions.
• And particular knowledge and skills.
• So there probably is such a thing as “care home medicine”
• But it is a concept in evolution – watch this space….