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Frail elderly patients in the UK need a form of care that we are not used to delivering. For these patients, healthcare is not about surviving and recovering from illness; it is about living with it, managing it and seeking a good quality of life in spite of it. These are patients with multiple medical conditions for whom managing the impact and symptoms of their problems is a daily experience. They often have impaired cognition and are easily disorientated. Their medical needs ebb and flow, but never go away entirely. They often have limited mobility and find it difficult to travel.
What these patients need is routine oversight and expert multidisciplinary input into their ongoing problems. They need it to be easy to access, expert and delivered close to their own homes. They need rapidly accessible support on their bad days, expert assessment of their deterioration and time given over to planning what to do in the future when their situation inevitably deteriorates. What they are given, however, is a fragmented array of interventions and services that do not reflect their needs; often, consultant expertise is only available if they travel to the clinic or the hospital. In the absence of advance care planning they are admitted to hospital as emergencies for the want of appropriate community services that could meet their needs. Community-based care is offered by narrowly defined teams, which can mean that patients experience multiple visits from carers and healthcare professionals without one team taking an overall lead in their care needs. I once met a patient who, during the space of 1 day was visited by her carers (three times), the district nurse, the palliative care team, the tissue viability nurse and her GP. In her …
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