HOSPITAL SERVICES: ACCESS AND AVAILABILITY
Most access to hospital should be via the GP (general practitioner). In some urgent cases the admission may be via A and E and the GP is unavoidably bypassed. However, in all other cases the GP should arrange admission. This may mean talking to the hospital doctors directly or arranging for the person to be seen in an outpatient clinic. The GP has a wide range of choice and just because a person is elderly does not mean that they should automatically see a geriatrician. The problem may be very specific and the GP may feel that another specialist is necessary, e.g. a cardiologist (heart specialist).
However, geriatricians and psychogeriatricians probably offer the widest range of services available to older people. In some districts all people over the age of 65 are seen by geriatricians, in others the age varies, perhaps above 75 or 80. This is known as an age-related policy. Other districts do not operate this scheme and the geriatricians tend to see those elderly people with specific problems: this usually means the very old and frail and those with multiple medical and social problems needing all the expertise of the multidisciplinary team (a so-called appropriate referral or appropriate care service). Many hospitals try to integrate their general physician consultants and the 'care of the elderly' specialists; the exact model will vary according to location and local needs.
The services available within a unit for the elderly usually include beds in the main district general hospital, for the acute admission and sorting out of complicated medical problems. Admitting the acutely sick elderly to beds in isolated one specialty hospitals is now regarded as inappropriate and all districts should have their acute beds on the main hospital site. This means that the elderly are then able to receive all the support services they need -X-ray, specialist opinion, operating theatre, intensive care, etc. Some beds are called rehabilitation beds and are for those patients with special mobility problems (after a stroke, Parkinson's disease and those recovering after a fracture or fall).
As many elderly people present with their acute illness as an acute confusional state, some hospitals have wards with special expertise in dealing with the confused elderly person. These wards are often jointly run with a psychogeriatrician so that their expertise is available. Geriatricians and psychogeriatricians are the only consultants with continuing care beds (that is beds that the person can remain in for good). These beds are scarce and very expensive to the health service. This means that no one should be assigned a continuing care bed until everyone is certain that it is the correct course of action. Increasingly, multidisciplinary teams are forming panels to vet potential applicants so that the person in need gets the type of care exactly suited to them and their carers.
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GENERAL HEALTH
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