Senior health

Senior health is a branch of General medicine that is concerned with the clinical, preventative, remedial and social aspects of illness in old age.

The challenges of frailty, complex co-morbidity, different patterns of disease presentation, slower response to treatment and requirements for social support call for special medical skills.

Presentations of illness in old age are often non-specific. Geriatricians focus on falls, immobility, incontinence and confusion as well as adverse drug reactions.

The gold standard treatment for frailty is a comprehensive geriatric assessment. This involves close inter-disciplinary working with nurses, therapists, pharmacists, dietitians, social workers and many other health professionals in order to develop a coordinated and integrated plan for treatment and long-term follow-up.

The Senior health service provides a comprehensive range of  services ranging from acute services to rehabilitation and outpatient clinics. 

These services currently include:

• Acute senior health inpatient care based on three wards at St George’s Hospital
• Orthogeriatric liaison work and rehabilitation
• Older Persons assessment and liaison services (OPAL) in the acute medical unit and emergency department
• Inpatient rehabilitation services on Mary Seacole ward at Queen Mary’s Hospital
• Inpatient rehabilitation services at Ronald Gibson House
• Outpatient clinic at St George’s Hospital
• Outpatient clinic at St John’s Therapy Centre and Queen Mary’s Hospital (Wandsworth)
• Outpatient clinics at the Nelson Centre; Holistic assessment and rapid investigation-HARI
• Day Hospital service at St John’s Therapy Centre and the Bryson Whyte Rehabilitation Unit at Queen Mary’s Hospital
• Wandsworth community ward/complex care team MDT input
• Access to specialist advice for GP’s via the Kinesis system
• Dementia and Delirium liaison services

The department is also in liaison with colleagues in the Department of Psychiatry of Old Age based at Springfield Hospital.

HARI – Holistic Assessment Rapid Investigation

HARI is a multidisciplinary ambulatory service for adults with complex medical and rehabilitation needs based at the Nelson Health Centre. Patients can be referred who are registered under a Merton GP.

Read more about HARI here: https://www.clch.nhs.uk/services/holistic-assessment-rapid-investigation

OPAL – Older Persons Assessment and Liaison Service

The OPAL team is base in the acute medical unit and in reaching into the emergency department. The OPAL team is a team of senior specialist nurses, geriatric consultants and support from physiotherapy and occupational therapy.

Optimal care for elderly patients requires knowledge of age-related physiological changes, complex co-morbidities, multidisciplinary team work and advanced care planning.

Our population is ageing and multimorbidity and frailty is rising. Recognising and managing frailty proactively is key and the cornerstone of managing frailty is comprehensive geriatric assessment (CGA). We need to use clinical judgement and personalised goals when deciding how to apply disease based clinical guidelines in the management of older people with frailty

The OPAL team aims to identify patients with frailty early on in their presentation to hospital, initiate CGA and generate a realistic personalised care and support plan.

The OPAL team work aims to reduce avoidable admissions/prolonged admission of frail older people  where possible, as well as to help zone patients to the most appropriate area of admission and to provide guidance on discharge from the point of admission.

The OPAL team will refer patients to specialist community pathways and services on discharge where appropriate and link with social care links voluntary sector support.

During admission to the acute medical unit the OPAL team aim to support early mobilisation of patients to reduce risk of deconditioning, to manage expectations of patients/carers, to explore an individuals values  and priorities and to improve continuity of care for the frail elderly.

Contact details: Alison Fitzgerald, OPAL Lead Nurse
Bleep: 7172/7173
Email: opal@nhs.net

Orthogeriatric Liaison Service

Fragility fractures carry significant morbidity and mortality. Patients who sustain hip fractures are also very likely to have numerous serious medical comorbidities. In 2007, the British Orthopaedic Association published The Care of Patients with Fragility Fracture (the “Blue Book”) in conjunction with a number of other professional organisations including the British Geriatric Society. This outlines the best practice in care of this patient group. 

Orthogeriatric liaison involves geriatric input into the care of older patients with hip or other fragility fractures during their inpatient stay alongside orthopaedic care. Currently these patients are on Gunning and Holdsworth ward (5th floor St James wing). During the orthogeriatric assessment, pre-existing or acute medical conditions are addressed, as well as falls risk and bone health. The team have well established links with rehabilitation services. 

St George’s Hospital is one of four London major trauma centres. Since 2017 the Orthogeriatric team have been involved in the care of older patients admitted with major trauma, providing comprehensive geriatric assessment to those patients with pre-existing medical co-morbidity and multiple acute injuries.