Need for Old Age triage @ A&E

It is essential that a specific triage service is core to all A&E services in my opinion. There is a modal (RAID) which saves £4 for every £1 spent. Furthermore, older people feel more vulnerable in A&E settings, and less able to advocate for themselves, especially if there is superadded delirium, dementia, depression or pain.

I think this type of attached service should be financed and managed by the acute trust rather than a mental health trust, as there tends to be a conflict of interest between protecting old age psychiatry beds and providing the best care for the person. in addition, mental health services do not have access to setting up immediate community service back up, which is easier for the acute trust to arrange.

Without a credible elderly assessment and diversion service any other LEAN provision is bound to fail in the current demographics.

I have to declare an interest, I am a Consultant in Old Age Psychiatry.

3 Replies

  • I think elderly people have all sorts of problems, but it is often only one thing that creates the need for them to be at A&E eg an X-ray to find out whether they have broken a bone in a fall.

    A lot of the expertise and scanning equipment is at the hospital rather than available for GPs.

    Once an elderly person is in the hospital it is a slow process to discharge them and 'send them home' and they are more weak and vulnerable in any event. So perhaps what is needed is a more clever way of investigating underlying problems without needing their physical presence at the hospital - or for a much shorter, defined period.

    The demographics make this an increasingly severe problem.

  • Specialist Old Age triage makes a lot of sense; I haven't heard of the idea before. Are there any plans to roll it out? I used to work in an A+E and the mismanagement of elderly people in a rushed department is almost par for the course. Getting elderly patients out of the rather Darwinistic environment of standard A+E triage would be wonderful.

  • Wise words regarding triage but also mentioned that many people are not in a position to self-advocate, so if advocacy is needed how about linking triage in so that the triage assessment includes whether or not someone is in a position to self-advocate and if not to trigger an advocacy service

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