Assessment of Older People's Health and Social Care Needs and ...

What Screening Tools are NotScreening tools are not a replacement for appropriate training, appropriate philosophy or adequateservice provision. A cogent example of this is provided by a survey of companies' health and safetypolicies. Those companies with a very good accident record have almost no paperwork on health andsafety policies because they have incorporated the philosophy, underpinning health and safetypolicies into their practices. In health care, we want to get to the point where we have incorporatedthe philosophy underlying screening and assessment into everyday practice.Limits of Tools and PoliciesThere is a danger in relying on tools and policies alone to solve problems. In the USA, there wasconcern that the quality of care in nursing homes was inadequate. Rather than responding withspecialist medical and nursing care and appropriate levels of therapy for patients, the authoritiesintroduced the Minimum Data Set (MDS-RAI). Subsequently, there has been, for example, no changein pressure sore prevalence". Tools and policies are subsidiary to getting appropriate training,philosophy and services in place._1------------------------------PrinciplesWhat is at the core of geriatric medicine? We assess and then prioritise, because very often there's arange of illnesses to respond to. We treat treatable disease, minimise medication, rehabilitate and,having done all of these things, we then, and only then, introduce compensatory techniques.The goal then of the Comprehensive Geriatric Assessment is individualised assessment leading toindividualised treatment of older people.SkillsThere are specific skills needs for staff working in geriatric medicine. Some groups will hopefully getpostgraduate training in the area because they have to work with patients who have multipleillnesses and attenuated presentations. There are very well defined knowledge bases for functionalloss such as falls. We need dedicated team work, diagnostic facilities and therapeutic facilities.11. Coleman, E.A., Martau, J.M., Un, M.K., Kramer, A.M .. 'Pressure Ulcer Prevalence in Long-Term Nursing Home ResidentsSince the Implementation of OBRA'87'. J Amer Geriatr Soc 2002, 728 -32.Conference Proceedings