Interface geriatrics: modernising conventional geriatric medical care

Nowadays managing elderly acute medical admissions is a big challenge in hospitals as the numbers of patients at age 75 and above admitting to acute medical beds are rapidly growing more than any other age group over the decade. Admissions of this particular age group significantly increased up by two thirds from 2000 to 2010.¹ In this situation, effective acute geriatric assessment and care is more important than before. Therefore, the conventional geriatric medical care should be innovated and modernized to meet the health needs of rapidly growing elderly acute admissions.

A study done by a group of researchers based in Leicester highlighted that elderly patients had risks of long inpatient stay, quick discharge of these patients did not always serve them well and therefore specialist geriatric assessment was needed for better overall outcomes.² On the other hand, 55% of elderly frail patients discharging back to the community from acute medical care were readmitted and about 26% died in the following 12 months.³ All these circumstances pointed that these (elderly) patients should receive comprehensive geriatric assessment on admission and a clear integrated care pathway should also be established in between community and secondary care (acute hospital). These requirements motivated the birth of ‘interface geriatrics’, the new integrated geriatric care bundle. It can be defined in various ways but its core principles are implementation of rapid comprehensive geriatric assessment to acute elderly admissions in hospital and harmonious combination of hospital and community geriatric cares.⁴ A care model of interface geriatrics can be seen in Fig 1.

Fig 1.

A model of interface geriatric care pathway.

In this care bundle, all elderly acute admissions such as patients age 75 and above must be promptly seen and assessed by a multidisciplinary geriatric medical team on admission such as in acute medical assessment unit rather than waiting for these patients being transferred to a care of the elderly ward. Implementing this care approach can lead to various benefits in acute care of the elderly such as avoiding unnecessary admission, reducing length of inpatient stay, organising comprehensive discharge care plans, reducing delayed discharge and reducing the risk of re-admission. A mapping review on current studies and trials about interface geriatrics showed that this care pathway could provide positive outcomes to frail, elderly patients admitting to acute medical beds.⁵ The DEED II study, a randomised controlled trial in Australia, conveyed messages that a compressive geriatric assessment integrating primary and secondary cares could reduce readmissions by about 25%.⁶ And participation of a geriatrician as a part of a community care team reduced the need of access to acute medical service and unnecessary admission.⁷ The cost-effectiveness of an interface geriatric care pathway is not evaluated scientifically so far in various studies but it can be generally justified that such an integrated care pathway provides benefits in term of funding and commissioning.