Concerns about elderly patient care

The Health Secretary’s recent statement on proposed future Social Care plans suggests that the ongoing debate in respect of how much the elderly are required to pay towards the cost of their residential care is set to continue long into the future. But whilst that debate develops, perhaps the Government should also focus its attention on the level of care that is experienced by elderly patients at hospitals and care homes.

A report by the Care Quality Commission (CQC), the health watchdog, found that half of all hospitals that it looked at failed in standards of care for the elderly.

Dame Jo Williams, Chair of CQC, concluded: “The fact that over half of hospitals were falling short to some degree in the basic care they provided to older people is truly alarming, and deeply disappointing.”

The report identified three underlying themes that can lead to poor care:

  • Lack of leadership: the report said that in some hospitals, unacceptable care had been allowed to become the norm.
  • Staff attitudes: “Time and again we found cases where patients were treated by staff in a way that stripped them of their dignity and respect,” reported Dame Williams. She added that care has become task-focused rather than person-centred, and often “puts paperwork over people”.
  • Resources: the report pointed out that having plenty of staff does not guarantee good care, but not having enough staff ‘is a sure path to poor care’.

The CQC said that leaders in hospitals at all levels must create a culture in which good care can flourish, and staff should be trained and managed in a way that nurtures high-quality care. It says that staff must have the right support if they are to deliver compassionate and effective care and managers must ensure budgets are used wisely to support frontline staff.

We encounter increasing numbers of claims for clinical negligence on behalf of elderly patients; both relating to treatment and/or care received in hospitals and, to a lesser extent, residential care homes.

Clinicians who care for older patients have often noted that elderly patients who are unwell may not present in the same way as a younger person with common illnesses presenting quite differently.

For example, a myocardial infarction (often referred to as a ‘heart attack’) often presents with typical symptoms of chest pain (with pain typically radiating down the left arm or the left side of the neck into the jaw). With elderly patients, this often produces shortness of breath, anxiety and can lead to a fall leading to an injury – unless alerted to the symptoms which led to the fall, it can lead to a missed diagnosis.

Another example is pneumonia, where an elderly patient presents in a confused state and/or has had a fall – the patient may only be diagnosed with pneumonia following a chest examination or x-ray.

A further example is where a peptic ulcer can lead to peritonitis, causing acute abdominal pain in a younger patient with rigidity and rebound tenderness (the pain increases when the patient’s hand is lifted during abdominal examination). An elderly person with the same symptoms may present with none of these features, but may only be diagnosed following an incidental finding for example, during an x-ray performed for a suspected chest infection.

Whilst we always hope that reports such as those referred to above would lead to direct action being taken, and improvements being made, the staff treating elderly patients need to be aware that matters from which a patient complaints or presents with, particularly in respect of elderly patients, clearly may not be what they seem.

If you feel you have been misdiagnosed or a relative has suffered health complications because of clinical negligence or mistreatment, please call Clare Gooch on 020 8891 6141 or e-mail