Internal geriatric liaison service

The care pathway followed by the geriatric older patient begins at home. The hospital is only one stage, and coordination of care, whether at home or in an institution, is essential. The geriatric team maintains strong contacts with general practitioners, home care services, rehabilitation centres, day centres, and nursing and care homes to coordinate the care provided as effectively as possible. It also arranges transport and provides continuing education for nursing and care home staff. Good communication is essential. The purpose of inpatient care is to assess the potential and resources of frail older patients who cannot be assessed in the Day Hospital, with a view to proposing a care and discharge plan aimed at maintaining the older patient’s independence. The department offers the expertise of a multidisciplinary team that assesses the patient’s functional, cognitive, nutritional and social potential, among other aspects, while treating diseases in accordance with current recommendations.

The main geriatric syndromes treated by the team include falls, memory disorders, confusion, loss of independence, malnutrition and dysphagia, urinary incontinence, etc.

Acute inpatient ward

The purpose of inpatient care is to assess the potential and resources of frail older patients who cannot be assessed in the Day Hospital, with a view to proposing a care and discharge plan aimed at maintaining the older patient’s independence. The department offers the expertise of a multidisciplinary team that assesses the patient’s functional, cognitive, nutritional and social potential, among other aspects, while treating diseases in accordance with current recommendations.

“Liaison” geriatric care

The Royal Decree defining the Care Programme for the geriatric patient stipulates that frail patients aged 75 and over must be assessed by a multidisciplinary mobile geriatric team. The care units screen their patients for frailty upon admission and then contact the liaison team, which provides care recommendations tailored to each patient’s medical and psychosocial situation. The liaison team provides geriatric expertise to the hospital’s medical and surgical departments.

The geriatrician therefore has multiple conditions to treat, including geriatric syndromes such as:

• Polypharmacy and inappropriate prescribing
• sensory deficits, such as hearing loss or visual impairment
• falls and trauma, which may have more serious consequences at an advanced age (for example, a fracture of the neck of the femur)
• osteoporosis and osteoarthritis
• neurological diseases, such as dementia
• depressive disorders
• cardiovascular and respiratory diseases
• nutritional disorders
• sleep disorders
• complex social issues.
• The involvement of a geriatrician in a care pathway

The health problems frequently encountered by older people may sometimes require planned surgery, chemotherapy or radiotherapy in the event of cancer, minimally invasive interventional techniques such as TAVI (treatment of aortic valve stenosis), or dialysis in cases of severe kidney failure.

The decision to intervene may depend on numerous factors, relating both to the disease itself and to other conditions the person may have, or to the combination of specific issues affecting older people, such as malnutrition, memory or mood disorders, loss of mobility, and so on. The specialist physician, surgeon or other healthcare professional therefore seeks the opinion of the geriatrician and their team in order to prepare the patient as effectively as possible before the procedure or treatment, by addressing the geriatric issues. This assessment takes place either during an inpatient stay or in a geriatric day hospital.

Inappropriate prescribing of medicines in older people

The number of conditions affecting older people can lead to an accumulation of medicines that cause side effects, interact negatively with one another and sometimes result in hospital admissions that could have been avoided. The geriatrician and clinical pharmacist can make treatment recommendations to prevent complications associated with inappropriate prescribing.