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Hospitals 'failing elderly patients'


Hospitals are failing elderly patients, with many suffering unnecessary pain, a report has found.

More than one in five also experience “significant delays” between admission and their operation, which reduces their chances of recovering.

The study, from the National Confidential Enquiry into Patient Outcome and Death (Ncepod), examined more than 700 patients over the age of 80 who died in hospital within 30 days of undergoing surgery.

Just over one in three (38%) had received good care, 44% received care that could have been improved and 6% received care that was less than satisfactory.

Poor nutrition and serious illness linked to it were “very common” among the group, the study said.

A quarter of hospitals had no acute pain service, meaning people suffered unnecessarily.

In 68% of cases, patients were not reviewed by elderly care specialists, despite recommendations a decade ago that this should happen.

Report author and Ncepod clinical coordinator in surgery Ian Martin said: “Most patients were admitted as emergencies by very junior doctors without timely input of senior care of the elderly clinicians.

“There is still a long way to go to ensure good practice and appropriate care - this is despite our advice in 1999 and recommendations in the 2001 national service framework calling for specialists to be involved at every stage of elderly care.”

Ncepod clinical coordinator in anaesthesia, Dr Kathy Wilkinson, who also worked on the study, said pain was not monitored, addressed or controlled.

The authors of the report said it should be treated as high a priority as heart rate and blood pressure.

“It is shocking that the survey has revealed organisational failures to respond to the suffering of elderly patients,” Dr Wilkinson said.

“I hope our report is a wake-up call.”

The study, An Age Old Problem, said patients being admitted to A&E with diarrhoea and vomiting, or signs of infection, need to be assessed by a doctor with the right kind of expertise.

Care services minister Paul Burstow said: “This study paints a disturbing and unacceptable picture of the quality of care experienced by older people.

“It is part of the legacy of a system driven by targets and tick boxes.

“This report is a snapshot of the state of the NHS two years ago.

“Clearly, more must be done to improve the quality of care. That is why the coalition government is determined to make the NHS more patient-centred.”


Readers' comments (6)

  • My Dad is in hospital at the moment after having fairly major surgery. The standard of basic nursing care post-operatively has been appalling, and a disgrace to the profession. His wound broke down post-op, and he had to go back to theatres to have it reopened, cleaned and resutured. He is now receiving NG feeds overnight and IV Fluids, as it is felt that his wound complication was as a result of poor nutrition. He had lost a significant amount of weight in a week and a half, and was also referred to mental health because he was so confused. He was not assisted to wash, brush his teeth or shave in over 9 days either. What happened to basic nursing care? It seems to have gone out the window!

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  • This is appaling.

    Why are elderly patients being treated as second class citizens?

    Admission to hospital for the elderly is often a highly dangerous option and can be a death sentence for them. Apart for the reason for hospitalisation the elderly often remain healthy, physically fit, mentally alert and independent until advanced old age and may still be useful and active members of the community and have dreams, plans and aspirations like the rest of the population but the hospitals, through negligence, often put paid to this and their lives can be ruined through iatrogenesis despite theri duty of care!

    The authorities and the NMC seem to watch our every move and we all live in fear of being charged for the slightest error we make so way are these cases of gross negligence and damage to our patients an exception which are allowed to slip through the net? Are no nurses and other medical staff capable of noticing the signs of the deteriorating condition of patients? Are they incapable of taking simple preventitive measures such as ensuring that patients have the correct and appetising diet and an adequate fluid intake? Are they totally incapable of detecting early signs and treating these?

    Whether staff feel that they are overworked, need more pay, are being ignored by the government, etc. they must be remined that they are still employed and being paid to do a job which involves being entrusted with the care of the precious, invaluable health of a nation. If they provide negligent care, which may be worse than none at all, they are increasing the bills for that care in the needs for further treatment. A healthy nation means lower bills for the NHS and for the country so that funds can be concentrated in the NHS where they are vitally and desperately needed - all fairly plain common sense.

    As an example a friend's 80 year old normally very alert mother was admitted to hospital and more or less ignored in the corner of the ward. The nurse pointed out to her daugher that she was confused (good reason not to bother with her too much!?) but my friend, not a nurse, noted that she probably hadn't been offered sufficient fluids. Her diagnosis was correct and thanks to her own simple actions her Mum was quickly restored to her usual bright and intelligent self. Why does it need a relative and a non-professional to point this out to qualified nurses? The poor overworked nurses are naturally too busy, rushed off their feet and highly stressed with more important tasks than observing and caring for the basic needs of their patients. Nurses, who on every visit she made, were milling around a desk doing nothing but chatting. Any form of action following visitors' requests for assistance or for a bedpan were usually postponed. Many patients desperately hold on until their visitor arrives to get a drink, go to the w.c. or get a bed pan or help with feeding and sometimes washing too as they are made to feel that the poor dear delicate nurses are always 'rushed off their feet' or 'too busy.' Even many nurses have dire stories about their own or their relatives care in hospital but it doesn't seem to change their attitudes towards their patients, their adhesion to their code of professional and ethical conduct or this totally unacceptable situation.

    Management may be partly to blame but it is up to the nurses to educate them as to what needs they have for their patients as it is the nurses who are in closes contact with them and responsible for the delivery of adequate care.

    The health authorities and the government are responsible for their shortsigntedness in employing too many non-clinically trained managers. It would be better if these were only involved in the real management of non-clinical services and not in the care of patients, where they may be able to a good job which does not require clinical expertise such as hotellery, property maintainance, grounds, transport, finance, etc. etc. although some departments such as hotellery for the patients and budgets also need the presence of a clinician to determine patients' needs.

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  • Well i'm sure that nutrition isn't the only cause of wound breakdown let me assure you.

    there are many other reasons.

    * Poor wound closure
    * If it was bowel surgery then that is not a clean operation so it could have broken down from the inside out.
    * Nurses concerns could ust have easily been ignored by the surgical team (not that uncommon)
    * Lack of appetite/dislike of hospital food (unbelievably common!)
    (didi you bring food he likes?? that is something we cant actually do)
    * He might not have actually sailed through the op in the first place.
    *The fact that the elderly are often chronically malnourished beforehand does mean that you have to play the 100 mile catch-up which isn't as easy as you make out.

    It isn't a simple case of nutrtion, in my view that is far too simplistic. Too keen to blame the nurses if you ask me - not an iota of blame directed to the surgical team i note!

    NG feeds and IV fluids are routine after alot of operations as is TPN.

    Actually washing and shaving has little direct effect on the recovery of a wound.

    Was he capable of doing these things beforehand? If so seems a bit churlish to say these things are the nurses responsibilty. Unless his arms were out of commission those are things he should be doing.

    He might be telling you they aren't doing it but why isn't he?

    If he is elderly (above 75) then you can't expect him to bounce back like that. People in their 40's and 50's don't sail through maor surgery either you know.

    Was there effective pre-op information or was it an emergency. If there was prep then really what to expect should have been laid out clearly but then again even surgeons don't advise patients to take a stake in their own lives and do things like look down to see if your gown is soaked thorugh from a leaking wound.

    BAsic nursing care is on the periphery of post-operative nursing. Obvsiouly the failiures are known to you so i'm making educated guesses.

    There isn't actually some guarantee that everything would be alright and dehiscence of wounds is like, one of the main post-op complications - not a rare one!! so it's a bit silly to make out that it was never on the cards. It's alwayon the cards that a wound might break down.

    Elderly skin doesn't heal all that brilliantly either.
    Was his absorption comprimised? Was he subject to a NBM order or FF/CFF regime?
    Was he physically active beforehand?
    Was he positive about the surgery or anxious? paranoid? nonchalant?

    There is more to post-op care than basic care and nutrition. The op is the easy part

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  • To the second poster, unless your freind was there 24 hours a day then i doubt she's a good judge of whether people are good workers or not.

    If she came in visiting hours then that is a lull in the day which we try to take advantage of. And unless she was actively listening in to conversations she could have mistaken team communication, handovers and the rest of the work we do to.

    I think it would help if you could abandon this whole

    'Nurses aren't allowed to talk to each other, be seen enjoying each others company, be observed to be inert and not constantly moving.'

    Nursing education as it is does not effectively prepare nurses for hte workload and demands they face. What you think are the basics of nursing don't exist in current education - but there is little nurses can do about that other than strive to maintain their own knowledge as hospital trusts are less than forthcoming with useful, useable knowledge.

    So long as basic nursing is forced to the forefront things like fluids drift to the periphery. If you want basic nursing than dehydration and poor nutrition is what you get.

    But don't forget hospitals employ dieticians also!!!! We can't do everybodies job and trust me i am currently doing a portion of everyone else job whilst none share any of mine.

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  • Well said!

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  • I think everyone is entitled to their own opinion, as a nursing student I too have witnessed unfair 'blaming' of only the nursing staff, when there was a lot more 'blame' to be associated with the consultants and surgical team.
    Its all about heirarchy, hence the higher you are the more it appears you 'get away with'.

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