P-188: Break the revolving exit door: a case of collaboration to address complexity in older people's care

摘要

Introduction: In the acute hospital ward, time and other pressures can limit clinicians from fully addressing the biopsychosocial issues underlying older people's frequent admissions. We present a case to illustrate the need for full biopsychosocial review by multi-specialty collaboration, key to good outcomes in the complex older population. Methods: Retrospective review of the patient's medical and psychiatric case records. Results: A socially isolated 89 year old female, known to have frequent hospital admissions with multifactorial falls, had multimorbidities, significant polypharmacy and declined carers at home. She presented to medical teams with falls and challenging behaviour, appearing as an uncooperative older patient with severe dementia. Her admissions would lead to early discharge resulting in missed opportunities to correctly identify and address bradycardia and multiple other issues contributing to her falls. Review by the Dementia Liaison Service diagnosed mild dementia and a lady frustrated by her multiple unmet needs, particularly a lack of accurate aetiological diagnosis of her falls. She was considered an unsuitable candidate for a pacemaker by cardiology, secondary to the perception of her mental state and cognitive ability. Better understanding and reframing of the patient's presentations along with effective liaison with other specialities led to insertion of a permanent pacemaker, identification and rectification of an unsuitable home environment, holistic discharge planning, and ultimately a significant reduction in her falls risk. Key conclusions: Collaboration between acute medical teams and specialist older people teams improves complex patients' outcomes, by enabling a biopsychosocial approach.