Leicester’s interface geriatrics program seeks to diminish hospital admissions among the oldest old through comprehensive geriatric assessment

Much of the recent focus by health and social care systems has been on hospital admissions and how to prevent them.

However, preventing admissions among the oldest old is not easy. Several large-scale projects aimed at older people with varying levels of risk of admission, have failed to demonstrate either clinical effectiveness or cost effectiveness.

An alternative is to look at a hospital’s response to the increasing number of older people attending. Traditionally, emergency departments have not focused on older people and the emergency medicine curriculum has not covered geriatric medicine in any great detail. These factors, combined with the immense pressure of the four hour target, mean that the conversion rate (proportion of people attending that are admitted) is higher in the oldest old compared to any other group.

By introducing the principles of comprehensive geriatric assessment (CGA) into the emergency care axis, it might be possible to lower the accident and emergency conversion rate for older people. However, closing the front door–even with correct assessment–can prove insufficient if attention is not paid to the back

Interface geriatrics seeks to re-establish the link between primary care and secondary care by re-introducing the ‘G’ of CGA into emergency, acute and community care of older people.

Results from Leicester indicate that incorporating CGA in emergency departments reduced admissions in people aged 85 and over by 10 per cent, in addition, strengthening CGA in the community with a 25 per cent reduction in readmissions.

Dr Simon Conroy is head of service for geriatric medicine, University Hospitals of Leicester Trust