Lack of leadership limiting improvements in elderly care, commission finds

There is a more than threefold variation between areas in rates of emergency admission and occupied bed days for people aged over 65, while eighty per cent of those who stay in hospital longer than 14 days are over 65, according to the commission.

The commission notes that older people are admitted to all clinical areas within a hospital and therefore all doctors need to “acquire the right skills and values”.

It adds: “Hospitals can fix this issue, but the right leadership is too often lacking. Too many leaders are not copying others’ good practice. Leaders feel they are distracted by regulatory interference in measuring the wrong areas, and by tariff incentivising inappropriate things.”

The commission said that older patients with frailty should not be “punished” for the “system’s inability to provide what they need”.

“The commission believes that frail older people in hospitals should expect to receive best in class care wherever they are. It is within the grasp of the staff and management of acute hospitals to start improving the healthcare that they provide to these people today, within their current resources,” the report adds.

The fault should not lie with the patients but the system they are in, the commission concludes.

“We should never blame frail older patients for presenting inappropriately to hospital where we have designed a health system inappropriate to their health and care needs.”

Professor Oliver said the “principle business” of hospitals is “very old people living with multiple long term conditions so we have to get the offer right for them and not just wish they weren’t there”.

Hospitals should not be used to provide care to the frail elderly where their care would be more appropriately delivered elsewhere, the commission has concluded.

Instead, commissioners should invest in improving community care.

The report states: “No patient should need to be admitted to hospital due to a lack of home help, adaptations, and other straightforward and obvious requirements. Ensuring adequate community provision is in place is a commissioner responsibility, which will become more important as a consequence of demographic change.”

The commission points out elderly patients can suffer increased harm by spending longer in hospital.

Julie Moore said that “many potential harms” can happen to a patient when admitted to hospital.

She added that it was “vital” that the risk of patient coming to harm is assessed “as quickly as possible” in the admission. These risks include danger offalling, developing pressure sores, developing deep vein thrombosis and not being appropriately nourished.

The commission notes that ten days of bed rest for someone over 75 leads to 10 per cent loss of aerobic capacity and 14 per cent loss of muscle strength – equivalent to 10 years of life.

“We know that prolonging a hospital stay by even one day can have detrimental effects on an older person,” it adds.