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Ageing well in our General Practice waiting rooms – what can we offer?
The Intergenerational Report released in 2020 highlighted something many GPs, nurses, managers, and receptionists are very familiar with. People are living longer and there are rapidly increasing numbers of older people in our practice populations. The Gold Coast population has 18% of people aged 65+. Some areas such as the Gold Coast north region have 24% of the population aged over 65. Nationally there has been a 30% increase in this group based upon the 2016 and 2021 national census.
The care of community dwelling older patients now comprises a disproportionately increased workload for GPs. Encounters with patients aged 65 years or more accounted for 31% of general practice encounters (BEACH study 2015-16). Unfortunately, due to the defunding of the BEACH research program, current data is not available, but it will clearly be increasing rapidly, without the required increase in resources to match. This group of people is increasingly complex, with the number of medications used per person climbing after the age of 75 with at least 50% taking 8+ medications, and 40% having Chronic Kidney Disease (CKD) stage 3a or worse (eGFR less than 60mls/min). Think about the issues of delivering safe and effective care to this group in your practice if CKD is not identified in your prescribing software!
A major issue for about 20% of older people is the concept of “frailty”. Frailty is NOT normal ageing and it’s a myth that needs to be busted! Frailty does reflect a more rapid functional decline, and reflects the inability of a person to perform usual activities of daily living due to:
As clinicians caring for older people, we need to know a lot more about frailty and how to recognise it early, in order to improve the life experience for the 20% of our older people aged 65+ who will have it. There are many frailty definitions and assessment tools – clinical, research, simple and complex, functional only vs function/ cognition.
Frailty can be defined as “Functional and/or Cognitive Vulnerability” to minor stressors, and may have one or more of the following features:
Yet another way to think about it is as a multidimensional deterioration of function in cognitive, physical, and social domains. And all of us over 50 are at risk!
“Frailty” is now recognised as a chronic condition, and it occurs due to a combination of deconditioning and acute illness on a background of existing functional decline and is often under recognised. Frailty is a core factor for attendance at Emergency Departments, admission to hospital and premature entry to residential aged care facilities after an acute illness. Frailty early recognition and intervention can keep older people living better at home.
A “wellness model” of primary care-based rehabilitation/restoration for older people is possible when general practice, community aged care providers and other providers such as allied health and the Gold Coast Council collaborate to improve outcomes for older people. The evidence now shows that such intervention results in:
How do you recognise “Frailty”?
It is important to be familiar with new evidence-based frailty screening tools as it is no longer acceptable to respond by demeaning the older person with unhelpful comments such as “there’s nothing much to be done, it’s because you are getting older.” Evidence based responses now show:
can in combination slow the rate of functional decline, and frequently reverse decline if people are detected at the early frail stage.
Best practice in the care of older people can be found well described in the excellent publication “Fit For Frailty”, which is a joint collaboration between the British Geriatric Society and the UK Royal College of General Practitioners.
Two practice-based tips which are worth adding to our consults/care plans/health assessments for anyone aged over 75 are the FRAIL screen, and to weigh older people at every consultation.
Remember the simple questions for the FRAIL screen from Professor John Morley (geriatrician, St Louis, Missouri) which requires a yes/no response.
Fatigue-are you feeling tired or fatigued? (yes-score 1)
Resistance- Do you have difficulty walking a flight of stairs? (overcoming the resistance of body weight against gravity) (yes-score 1)
Ambulation- Do you have difficulty walking around the block? (yes-score 1)
Illnesses- Do you 5 or more chronic conditions? (yes-score 1)
Has there been Loss of weight of 5% or more over past 6 months? (yes-score 1)
Then what do you do about Frailty?
If the older person scores 2, they are pre-frail, and 3+ indicates they are frail and would benefit with:
If you would like to update your knowledge on this topic and others relating to the care and wellness of older people in your practices, please review the Gold Coast PHN website which now has a dedicated site for better care of older people. The section titled ‘Health Ageing resources,” will be added to over time with new referral options.
Here are some interesting links which can support you thinking about new ways to tackle the complex issues of ageing for yourself and your patients in a primary care practice:
And finally, your own self-care and ageing as a health professional does need to be considered! This recent BBC/ABC program discusses the issues of how to reduce the effects of ageing. Recommended viewing, as there is no pill for this!
More information in the next episode from Dr Chris Bollen MBBS MBA FRACGP FACHSM MAICD, Director BMP Healthcare Consulting.
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