"Of the many patients over age 75 on my medical unit, half are what providers describe as young old and the remainder as old old. Admittedly, this delineation is somewhat arbitrary and the subsequent assessment provides more nuance, but it helps us triage patient needs. Before the actual round, my team does a paper round. We run through the bread-and-butter issues of any internal medicine ward: heart failure, bad emphysema, rampant diabetes, cognitive decline, frequent falls, frailty."
"Besides the medical details, we scrutinise the social circumstances. Does the patient live alone? (about 35% of people over 85 do). Is there any home help? (the waitlist for services is painfully long). Who takes them out and how often? From the time patients enter the hospital, we need to know what it will take to get them safely out of hospital. The first of five nonagenarians is sitting expressionless in his room. He is cognitively impaired and has had a fall."
Patients over 75 are often categorized as 'young old' or 'old old' to guide triage, though the distinction is somewhat arbitrary. Clinical assessment addresses heart failure, severe COPD, diabetes, cognitive decline, frequent falls, and frailty alongside social circumstances. Care teams evaluate living situation, home-help availability, medication management, family contact, and mobility to plan safe discharge. Many elderly inpatients live alone, face long waits for community services, and lack regular caregivers, resulting in unmet basic needs like foot care and medication assistance. Cognitive impairment and communication barriers complicate history-taking and delay family involvement. Simple comforts and practical assistance are often missing, increasing patients' isolation and vulnerability.
Read at www.theguardian.com
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