Health  Service  Forum  South  East

Presentation given by Dr David Stewart to a meeting of the Health Service Forum S.E. on Tuesday 14 April 2009 in the Larkfield Centre, Govanhill

The chairman, Margaret Hinds welcomed everyone to the meeting and introduced Dr David Stewart, Consultant Geriatrician at the Victoria Infirmary, Glasgow.

He divided his presentation into four sections

1. Definition of Geriatric Medicine

2. History

3. Geriatric services in the S.E Glasgow

4. Future of Geriatric Medicine.

DEFINITION

The name Geriatrics is care of the old man now known as medicine for the elderly.

HISTORY

Back in 1942 an article appeared in the Lancet written by Dr Marjory Warren who described her experiences of caring for the chronically unwell. Up till then no one had looked at what was wrong with old people and no one had rehabilitation. It was found that with proper diagnosis, treatment and rehabilitation a huge number could be sent home. In 1947 the British Geriatric Society was formed. Comprehensive geriatric assessment was developed looking at all aspects of elderly health using a medical team.The first University Chair of Geriatric medicine in the world was created in 1965 in the University of Glasgowe. He and his colleagues made Glasgow the centre of Geriatric Medicine.

The Victoria Mansionhouse Unit was opened in 1972 and was the first geriatric hospital in Scotland.

Dr Stewart began his career in Geriatrics in 1982. By the early 1990s all acute elderly cases were admitted to the Victoria Infirmary to assess the level of care requiredbefore moving over to the mansionhouse unit.There are now five geriatric units in the city of Glasgow using the model of care deevised by the Victoria.

GERIATRIC SERVICES IN S.E.GLASGOW

Over the past ten years there have been changes. in a) subspecialisation b) community geriatrics

a) Geriatricians have areas of particular interest i) Parkinson's Disease/Molvement disorders ii) Stroke iii) Falls/fractures

i)Parkinson's Disease; Clinicas were started in the Victoria Inf in 1992. Prof Les Findlay published a new holistic and team model of caring for patients. The first in Scotland. The team consists of consultant, nurse specialist, Physiotherapist, Occupational therapist and speech therapist.

ii) Neurologists are involved in the Strke team and the acute unit is sited in the Southern General Hospital. Thrombolysis is carried out over the first few days following the stroke before the patient is sent to the Mansionhouse Unit.TIA clinics are also held.

iii) The team in the Victoria dealing with Falls is headed up by Dr Lennox in conjunction with the Community Falls Team.

In England Community Geriatrics is on the increase. As much care as possible is given in the home or close to home.

THE FUTURE

In the Victoria Ambulatory Care Hospital there are 48 rehabilitation beds in two wards. Ward 1 is the predischarge rehab unit. Patients are over their medical problems but not quite ready for discharge. This is a nurse led facility with consultant back up. Ward 2 is an orthopaedic geriatric ward.

The Parkinson's Clinic will be held in the new building.

The New South Acute Hospital will open in 2015. There will be 93 beds in the new adult hospital for the acutely ill elderly patients. There are presently 120 beds for geriatric patients in the Langlands Unit of the SGH.

When the Mansionhouse Unit closes there will be a need for nursing home beds for the elderly. The Health Board has 72 beds in Mearnskirk, 24 Beds are provide in the Rowantree/Rogerpark Nursing Home and 30 beds in the Darnley Court Care Home both Rowantree and Darnley are owned and run by BUPA.

Dr Stewart took questions from the audience.The main concern was over the increasing elderly population and the reduction in the number of hospital beds over the years.

He was asked what kind of personal plan is provided by the hospital. Community teams identify patients who can safely be sent home for rehabilitation. The Discharge and Rehab Team (DARTS) care for the patient until the social work team take over.

Margaret Hinds thanked Dr Stewart for attending.

On the basis that geriatrics are currently treated in the Victoria before being over to Mansionhouse. Mansionhouse Unit has 262 elderly beds.

Current position beds for rehabilitation on South of Glasgow

Mansionhouse Unit        262 beds

Victoria ACH                    48 beds

Mearnskirk                        72 beds

Rowantree                         24 beds

Darnley Court                    30 beds

Langlands SGH              120 beds 

                                         550 beds to serve the South Side of Glasgow

The Mansionhouse compliment may be reduced by 48 beds when the ACH opens in June 09

From 2015 the 93 beds in the New South Acute Hospital will accomodate acutely ill elderly. Once their condition improves they will be moved to a geriatric unit or nursing home. There will be 294 beds available once the Mansionhouse is closed.