Thushara Matthias: Caring for older patients

I’m a postgraduate trainee from a developing country and have completed my local training in internal and general medicine to be a consultant physician. The rest of my training involves mandatory “foreign training” in an overseas country of our choice for one year. In most cases, doctors from my region choose either the United Kingdom or Australia due to the ties we have with these countries’ medical systems.

When I arrived in the UK to work as a clinical fellow in acute medicine two months ago,  I was eager to start work on the medical short stay wards. As time has passed, I have learnt that each passing day we retain a few patients who are not going home despite being medically fit.

The consultant, registrars, and ward staff all sigh a familiar sigh when these one or two “problem” patients come up for discussion at each morning’s ward round. Everyday the notes conclude, “medically fit for discharge, awaiting package of care.” This is demoralising for the whole team as the solution is beyond our control. Even the most senior and influential consultants in the hospital are unable to sway things.

Older patients in hospital beds, awaiting packages of care seems to be quite the norm in the UK. It is said that bed days due to delayed transfer of care (DTOC) rose by 31% between 2013 to 2015 alone. Children or next of kin are not responsible for their elders. Realising this was a shock initially. As much as I agree that looking after our elderly and making sure they are safe once discharged is part of health teams’  responsibility, and part of the holistic care we provide to patientswhich should not bear boundariesI feel what occurs presently is further encouraging “bad” social behavior and also encouraging dependence on the government to look after the increasingly growing elderly populations.

Why many elders have no families to take care of them eludes me. The many plausible reasons include smaller family sizes, children moving out of family homes at a younger age, more female employment, and modern living. However, in my opinion, the most obvious reason is the lack of commitment and family ties. Some say this is less of a problem in developing countries as families look after their elders. But consider that low pensions and poor health insurance schemes offer no greener pastures for the elderly living in developing countries, despite it being more likely they will have families to look after them.

One might wonder why governments of developing countries are less worried about discharging patients home once they are medically fit. This may be because the threat of legal action against hospitals is less of a problem.

Over recent decades, many developing countries have seen their fertility rates drop and average life expectancy has  risen significantly. It is said that nearly 60 percent of the world’s over-60 population resides in the Asia Pacific region, and this will quadruple by 2050.

Only the future will reveal how the developing countries in Asia will handle the problems that ensue from this expected increase in  their elderly populations.

My personal view point is this: whether we are from the east or west, all of us have a responsibility to look after our elders without letting them create a burden on their country’s national health system.

Thushara Matthias is a currently a clinical fellow in acute and general internal medicine at Addenbrooke’s Hospital, Cambridge. She has completed her training in Sri Lanka.

Competing interests: none declared.