Summary in English

As we age, we become increasingly prone to illness and functional impairments. Older people tend to develop more chronic illnesses and take more medications than younger people and are more frequently in touch with the health and care services than younger people. Ensuring the provision of appropriate and satisfactory health and care services for this patient group is essential, particularly considering ongoing demographic changes resulting in an aging population.

The supervisory authorities receive data about the health and care services through reports on serious incidents, individual complaints and possible cases of professional misconduct, as well as through carrying out planned, preventive inspections and other supervisory activities. To convert these data into knowledge about the services, we need to be able to view the data in context. This requires systematic review and collation of data.

In this report, we summarise information from our supervisory activities relating to specialist healthcare services for older patients. We collate data sources from supervisory activities that have not been systematically reviewed previously. This provides us with important information about risk areas, as well as information about our own data sources and limitations to these.

Our analysis show that cases relating to older patients primarily involve somatic healthcare services, as opposed to the rest of the population where mental health services are more prevalent. We also find that relatively few of the complaints received by the supervisory authorities are raised by older patients. However, older patients are overrepresented in cases concerning services delivered by both the primary and the specialist healthcare services. Few planned supervisory inspections have been carried out in recent years with a focus on specialist health \care services for older persons.

In this report, we describe the risk factors that emerged from analysing data from our supervisory activities. We present these by following the patient through all phases of medical care at the hospital, from the initial contact in the emergency department to admission to a ward and discharge to the municipal health and care services.

Some risk factors are particularly important:

A fragmented and highly specialised service

The fragmented and highly specialised specialist healthcare service is not appropriately organised considering the needs of frail older patients. The organisation itself entails a risk that the comprehensive needs of frail older patients will not be met. This could result in medical conditions not being detected or in unmet basic needs, such as mobility, dental care and nutrition. This could again lead to patients gradually declining during admission, despite receiving adequate treatment for the disease for which they were admitted.

Fundamental geriatric expertise

Fundamental geriatric expertise is required by everyone working with patients within the specialist healthcare service. If hospitals do not have personnel with geriatric expertise or specialist nursing skills relating to older patients and their special needs, there is a risk that such patients do not receive adequate and comprehensive healthcare.

A focus on the characteristics of frail older patients

Frail older patients often experience concomitant diseases, and this can result in a complex pathology. Older patients often experience cognitive impairments, and their ability to describe their own medical conditions and situation varies. This requires the attention of attending personnel, observation skills and sufficient time with the patient.

Cooperation between service levels in connection with the discharge of elderly patients

When older patients are discharged, either to their home or to various services within the municipal health and care services, there are several risks involved. It is of particular importance that the hospital plan the discharging of the patients, and that all relevant information is passed on to the municipal service responsible for the follow-up. The specialist healthcare service, whether inpatient wards, day surgery or outpatient clinics, must communicate with the municipal services to ensure that the patient receives adequate treatment and support following discharge. One possible consequence of poorly organised or premature discharge is that patients are readmitted to the hospital after a short period of time.

Medication treatment

A key risk factor is medication treatment, especially in relation to the transition from hospital to the municipal health and care services. This entails ensuring not only that someone assumes professional responsibility for ensuring that a comprehensive medication review is carried out, but also that someone has an overview of actual drug usage, which includes ensuring that the patient is prescribed the drugs they need and that they use them correctly.

Digitalisation of health services

If the plans for the digitalisation of health services are implemented as envisaged in the regional health trusts’ development plans, new risks will arise. In the context of ensuring quality services to older patients, it is of particular relevance to monitor how the specialist healthcare service prevents digital exclusion.