ACHA works with friends in high places to improve emergency care of older people

It’s hard to open a paper any given day without reading something about the difficulties faced by our acute hospital sector and emergency departments.  Older people living with frailty and/or dementia are amongst the biggest users of emergency and acute care services.  Half of the people arriving in Emergency Departments by ambulance are aged 65 years or older.  Older people are more likely to be affected by care delays in emergency departments that other age groups – the over 65s have seen a 25-fold increase of the likelihood of staying in emergency departments for 12 hours or longer since 2019.

Whilst it’s true that many people seen in Emergency Departments need to be there, it’s also the case that many could benefit from being seen closer to home.  London has some excellent examples of initiatives to deliver better care closer to home, including the Silver Triage system in North London and the Physician Response Unit and Hospital at Home Services based out of Barts Health NHS Trust.  Many older people are, though, unable to access these services.  Hospital at Home services – established across the Capital – are well accessed but are not equally well used by all patient groups, with particular challenges facing people living with dementia and chronic mental illness. We need to learn how to deliver care closer to home more consistently for all patients who could benefit across acute, community and mental health boundaries.

With this in mind, the ACHA team (Profs Liz Sampson and Adam Gordon, Lauren Ellis and ACHA affiliates Profs Nathan Davies and Simon Conroy) met with clinicians and researchers working as part of the Physician Response Unit (PRU) at the Royal London Hospital in early January 2024.  We discussed research to explore how virtual wards can meet the needs of older people living with dementia and and how we can better understand the impact of services like the PRU, so that more patients can benefit from proactive care closer to home.  We’ll be applying for funding to explore these areas with clinical colleagues in the near future and look forward to telling you more as ideas develop.

A fitting metaphor the morning’s discussions was provided by a trip to the helipad at the end of the session.  We ended up feeling we could see a little bit further than we had before, as we looked away from the hospital towards the communities we serve and tried to work out how to do things a bit better.