One in every six people is aged 65 years or older in Ireland today. The 2016 census showed that the number of people aged 65 years plus in Ireland had increased by 9.9% and the number of people aged 85 years and over had increased by 17.1% in the preceding five years. There is no doubt we are living longer. Positive ageing and increased life expectancy are to be celebrated but an ageing population places increased demand on both community and acute hospital health services.
Cork University Hospital (CUH) is working hard to ensure its health services are age-attuned and responsive to the specific and complex needs of older people, their families and carers. Cork city is the third fastest ageing administrative county in the State. According to Cork City Friendly City Strategy 2016-2020 it is estimated that one in every four of the population will be aged 65 years or older by 2050.
Good news then that CUH is leading the way – in February the Geriatric Emergency Medicine Service (GEMS) was recognised as the first Age-Friendly Health System in Europe. Some 12,500 people aged 75 years or older attend CUH Emergency Department each year - approximately 55% of these require admission for acute care. Dr Kirstyn James is a leading consultant with the GEMS team at the Emergency Department at CUH. She says the number of older patients presenting to CUH is increasing year on year, resulting in older people being amongst the principal service users of CUH.
Dr James who completed her Fellowship training at Harvard Medical School in Boston in 2020 says the concept of age-friendly health systems first originated in the US where 450 hospitals are accredited as being age-friendly health system.
An Age-Friendly Health System is one that provides care that is in keeping with what matters most to each particular older patient, “working through what we call the ‘4Ms’ of geriatric medicine: finding out what matters most (whether it is walking the dog or travelling or spending time with grandchildren), checking the mind (memory, thinking, mood), checking mobility (ability to walk and move, muscle strength, falls) and checking medication”.
Dr James says the ‘4Ms’ is a very useful framework when any medical team is assessing an older person “because when an older person comes to a hospital or a clinic they may be coming with one medical problem but it is very likely they have lots of other medical conditions too and these need to be looked at also”.
She explains that the system streamlines facilities for their patients. “We treat approximately 50 older, quite frail patients at the Emergency Department each week – our consultant-led service ensures rapid comprehensive specialist assessment and treatment”.
The team comprises of Dr James and a doctor in training, a physiotherapist and an occupational therapist both of whom have a wealth of experience treating older people, a clinical nurse specialist and the Emergency Department doctors and nurses. “We started this initiative back in September 2020 and we set ourselves a goal to be recognised as an age-friendly health system… we are delighted that we were successful in getting this recognition in February this year.”
At present there are six private assessment spaces for older people at the ED at CUH - each unit is designed to meet the needs of older patients, with inclusions such as proper doors to ensure privacy and quiet, adjustable lighting, bathroom and shower facilities, a calming colour scheme (research recommends yellow tones on walls and to avoid black and white floor tiles as they can appear like ‘black holes' in the ground for people with visual or memory problems and can cause falls).
Dr James says “we know from research in the US that three-quarters of older people are likely to attend ED in the final six months of their life so while older people come to ED when they are seriously unwell it is also at an important time when they may not want to be in a hospital and may want to prioritise what matters most to them. This might be spending time with family at home. It is important that we design all our healthcare systems but particularly our ED to be an age-friendly environment so we provide healthcare that meets their needs.
Going forward Dr James and her team would like to expand this service and the team at CUH.
“My hope is that this kind of care will spread to other teams caring for older people so it is not just the responsibility of doctors trained in geriatric medicine because it is important that everyone who works in healthcare with older people try and adopt an age-friendly attitude towards our care of older people”.
Covid-19 has shone a spotlight on the care of older people and so “if anything good is to come from this pandemic hopefully it is that we all pay closer attention to how we can deliver better care to older people and strive to create an age-friendly environment”.