Medical Professionals Online

Government's Prejudicial Health Policies Treat Elderly As A 'Lossleader', UK

March 19, 2017

The care of older people should be a central priority in the NHS but too often it is marginalised, neglected and plays second fiddle to initiatives or targets designed to appeal to younger voters, says a paper in this month's Journal of the Royal Medical Society.

Most NHS staff, argues author Dr David Oliver, will spend the majority of their careers working with older people and most health resource is expended on this group, but the current emphasis in education, training, research funding and government policy - and in media reporting - is skewed towards "sexier" areas of care.*

"Older people are the main users of the NHS: around 60% of admissions and nearly 70% of hospital bed days are devoted to people over sixty five. They are not a minority." says Dr Oliver, a senior lecturer and consultant physician in geriatric medicine.

"Yet you would never know it from the way healthcare is reported in the press, from priorities in research funding or government targets, or from the training of medical and nursing staff. Improving the care of older people is the key to transforming the whole system. We need to start providing public services based on need rather than on political demand."

The author notes how labels such as 'bed blocker', 'social admission' or 'acopia' are still being used in many NHS general hospitals and argues that these attitudes are affecting diagnosis and treatment of older people. Conditions such as falls, poor mobility, confusion or incontinence are lazily labelled as "social", when they are usually perfectly treatable conditions.**

Even when the patient has a more complicated condition or incurable illness, there is plenty more that could be done to enhance their dignity and choice, argues Dr Oliver. He describes a physician clinical director stating that "he was spending too much time 'market gardening' (i.e. caring for old patients who were 'cabbages')."

On another occasion, a surgeon arrived on Dr Oliver's ward and "laughingly announced that he 'didn't understand how anyone could stand to work in a ward looking after all these crumblies'."

Dr Oliver argues that because "geriatric medicine does not feature prominently in the curricula of many medical schools, nor sufficiently highly in the core curricula for post medical training…..some attitudes might be rooted in ignorance rather than malice or indifference." This lack of focus on training in geriatric medicine is reflected in the fact that most students and recent graduates in medicine and allied professions state that they do not wish to pursue a career working with older people.

Conservative estimates suggest that by 2025, people over 80 years old and those dependent on others for two or more activities of daily living will increase by 50%.

Dr Oliver suggests some possible solutions:

- Re-balance medical education and training to give staff the right skills to care for the patients they will actually see

- Shift the emphasis in research funding and governance a little more towards clinical and health services research on frail people

- Produce performance and inspection targets frameworks which place high quality assessment and care for older people at the centre of service delivery rather than its periphery - which in turn means targets which make a meaningful difference to older people rather than superficial 'box ticking'."

*A recent national survey of 1,600 health service managers; 'rated older people and those with mental health needs as the most neglected groups in the service and those which had benefitted least from NHS reforms'.

**Very common conditions, such as urinary incontinence (25% of the female population over 65), fractures resulting from osteoporosis (one in two women during their lifetime), acute confusional states (around 30% of patients admitted over 65), accidental falls (one in three people over 65 per annum) or dementia are under-recognised and under-treated, despite national guidelines.

' 'Acopia' and 'social admission' are not diagnoses: why older people deserve better' is published in the April issue of the Journal of the Royal Medical Society, volume 101.

JRSM is the flagship journal of the Royal Society of Medicine. It has full editorial independence of the RSM. It has been published continuously since 1809. Its Editor is Dr Kamran Abbasi.

The article will be available free at jrsm.

Founded in 1805, the Royal Society of Medicine is an independent organisation that promotes the exchange of knowledge, information and ideas in medical science and continued improvement in human health. rsm.ac Registered Charity No. 206219

Royal Society of Medicine