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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
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.
Tel: 020 8725 3503 / 020 8725 3502
Fax: 020 8725 2855
St John’s Day Hospital Team Reception
Tel: 020 8812 5377
Bryson White Rehabilitation Unit
Tel: 020 8487 6170
Fax: 020 8487 6147
Patient Advice and Liaison Service (PALS) offers information, support and advice about St George’s University Hospitals NHS Foundation Trust services.
Tel: 020 8725 2453
Outpatient Care Clinics
The Department currently runs the following clinics:
- St John’s Therapy Centre and rapid access clinic – Dr Joanna Preston – Monday am
- St George’s Hospital – Dr Joanna Preston – Tuesday am
- Queen Mary’s Hospital Rapid access clinics; Tuesday to Friday
- Queen Mary’s Hospital Movement disorder clinic: Wednesdays -Dr Duncan Gerry
- HARI clinic (Nelson Centre): Mondays and Thursdays: Dr Mark Cottee. Wednesdays and Thursdays – Dr Chris Sin Chan
General Geriatrics Clinics
We have a fairly open criteria for anyone living with frailty beginning to have difficulty. In these clinics, we assess older adults with a range of conditions and problems, for example:
– Reduced mobility
– Multifactorial weight loss (excluding 2 week wait referrals)
– Complex co-morbidities
Exclusions include new diagnosis of dementia and suspected cancers requiring urgent investigation under a two week wait.
The clinics currently have medical review only and run once a week at
– St. John’s Therapy Centre, Clapham Junction (referrals via SGH)
– St. Georges’s Hospital, Tooting (referrals via SGH)
– Queen Mary’s Hospital, Roehampton (referrals via QMH)
Rapid Access Clinics (RAC)
We run a daily rapid access clinic either at Queen Mary’s in the Brysson Whyte Rehabilitation Unit, or on the St George’s site. This is commissioned for Wandsworth residents only with the aim of obtaining a rapid review that will reduce the likelihood for admission. It is available to community practitioners only at present.
Referral is Bleep 144 or call Bryson Whyte on 0208 487 6170 to discuss referral (08:30 to 16:00 Monday to Friday). We encourage call to discuss referrals in the first instance. The referral form is available on DXS.
The email address to refer to is firstname.lastname@example.org.
Multi-disciplinary and Rehabilitation Services
Day Hospital at St John’s Therapy Centre, Clapham Junction
Brysson Whyte Rehabilitation Unit, Queen Mary’s Hospital, Roehampton
Both of these have access to review from medics, nursing, physiotherapy and occupational therapy as routine.