The role of primary care in supporting the elderly

By the time many elderly people seek treatment for a physical or mental incapacity, they are set on a course for a steady decline in their health. At this stage clinical treatment to help patients manage chronic health conditions may be all that’s available.

The World Health Organisation in the recent publication Guidelines on Integrated Care for Older People put the focus on early intervention; exploring how a holistic approach to ageing and associated health impairments can prevent, slow or reverse declines in physical and mental capacities among older people.

Instead of waiting for patients to present with a chronic disease and treating that in isolation, it’s about identifying declines in ‘functional ability’ and ‘intrinsic capacity’ that are often a precursor to more acute healthcare issues. These include a decrease in muscle strength, weakening eyesight, problems with mobility and cognitive impairment which can be early markers of declining health. When treated or monitored early, older people may be able to live healthier and better lives, and in turn reduce the burden on healthcare providers for acute services.

The new guidelines provide evidence that it is in primary care where there are opportunities to improve the long term health of older people; by addressing the comprehensive needs of patients rather than the conditions and complaints for which they seek treatment.

Getting the primary care infrastructure right

However, with many primary care providers overstretched and understaffed, how can GPs and community healthcare teams do more than treat the conditions they are presented with? WHO are calling for better integration between care providers, for example by providing more healthcare services in the community.

Recommendations include the following:

Mobility loss: multimodal exercise (strength resistance training, as well as flexibility, balance, and aerobic exercise). Some primary care providers are facilitating this with on-site exercise classes and by partnering with other healthcare providers.

Visual and hearing impairments: routine screening for visual and hearing impairments are best delivered in a primary care setting where older people are more likely to use these services.

Cognitive impairment: referrals to on-site cognitive stimulation therapies have the potential to delay the onset of dementia and even reverse declining cognitive capacity.

Depressive symptoms: depression is associated with a severe decline in functional ability among older people. Interpersonal therapy and cognitive behaviour therapies can be delivered in primary care settings.

There are clear benefits for older people if these services are delivered in primary care settings. Firstly, awareness will increase and therefore those on the frontline of primary care will be more likely to refer patients for additional support. In their guidelines the WHO do highlight the need for more awareness and training to help healthcare professionals identify the declines in intrinsic capacity and functional ability, having services on-site will put these at the heart of care for older people.

Moreover patients are more likely to use these services when delivered in the community, rather than in hospitals or through off-site providers. Instead of waiting until their condition deteriorates patients may also seek help earlier owing to increased awareness around these key issues; families too will be more aware of the support that is available for older patients. Primary care premises become a hub for all supporting services, increasing access by providing services close to where older people live.

Improving primary care premises and building purpose built primary care hubs, can help to create better integration between care providers. Here at Octopus Healthcare we are involved in a number of primary care centre projects with the aim of increasing healthcare services in the community. For an insight, read our recent case study on the Mullingar Primary Care Centre here.

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