{"id":37823,"date":"2016-11-22T15:44:00","date_gmt":"2016-11-22T14:44:00","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=37823"},"modified":"2016-11-22T16:18:01","modified_gmt":"2016-11-22T15:18:01","slug":"thushara-matthias-caring-for-older-patients","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2016\/11\/22\/thushara-matthias-caring-for-older-patients\/","title":{"rendered":"Thushara Matthias: Caring for older patients"},"content":{"rendered":"<p><span style=\"font-weight: 400\">I\u2019m 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 \u201cforeign training\u201d 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\u2019 medical systems. <\/span><\/p>\n<p><span style=\"font-weight: 400\">When I arrived in the UK to work as a clinical fellow in acute medicine two months ago, \u00a0I 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.<\/span><!--more--><\/p>\n<p><span style=\"font-weight: 400\">The consultant, registrars, and ward staff all sigh a familiar sigh when these one or two \u201cproblem\u201d patients come up for discussion at each morning\u2019s ward round. Everyday the notes conclude, \u201cmedically fit for discharge, awaiting package of care.\u201d 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.<\/span><\/p>\n<p><span style=\"font-weight: 400\">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) <a href=\"https:\/\/www.nao.org.uk\/report\/discharging-older-patients-from-hospital\">rose by 31% between 2013 to 2015 alone<\/a>. 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\u2019 \u00a0responsibility, and part of the holistic care we provide to patients<\/span><span style=\"font-weight: 400\">\u2013<\/span><span style=\"font-weight: 400\">which should not bear boundaries<\/span><span style=\"font-weight: 400\">\u2013<\/span><span style=\"font-weight: 400\">I feel what occurs presently is further encouraging \u201cbad\u201d social behavior and also encouraging dependence on the government to look after the increasingly growing elderly populations.<\/span><\/p>\n<p><span style=\"font-weight: 400\">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.<\/span><\/p>\n<p><span style=\"font-weight: 400\">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.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Over recent decades, many developing countries have seen their fertility rates drop and average life expectancy has \u00a0risen significantly. It is said that nearly 60 percent of the world\u2019s over-60 population resides in the Asia Pacific region, and this will quadruple by 2050.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Only the future will reveal how the developing countries in Asia will handle the problems that ensue from this expected increase in \u00a0their elderly populations. <\/span><\/p>\n<p><span style=\"font-weight: 400\">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\u2019s national health system.<\/span><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Thushara Matthias<\/strong> is a currently a clinical fellow in acute and general internal medicine at Addenbrooke&#8217;s Hospital, Cambridge. She has completed her training in Sri Lanka.<\/span><\/em><\/p>\n<p><em><strong>Competing interests<\/strong>: none declared.\u00a0<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>I\u2019m 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 [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2016\/11\/22\/thushara-matthias-caring-for-older-patients\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[223],"tags":[],"class_list":["post-37823","post","type-post","status-publish","format-standard","hentry","category-guest-bloggers"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Thushara Matthias: Caring for older patients - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2016\/11\/22\/thushara-matthias-caring-for-older-patients\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Thushara Matthias: Caring for older patients - The BMJ\" \/>\n<meta property=\"og:description\" content=\"I\u2019m 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 [...]More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/bmj\/2016\/11\/22\/thushara-matthias-caring-for-older-patients\/\" \/>\n<meta property=\"og:site_name\" content=\"The BMJ\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/bmjdotcom\/\" \/>\n<meta property=\"article:published_time\" content=\"2016-11-22T14:44:00+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2016-11-22T15:18:01+00:00\" \/>\n<meta name=\"author\" content=\"BMJ\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@bmj_latest\" \/>\n<meta name=\"twitter:site\" content=\"@bmj_latest\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"BMJ\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2016\\\/11\\\/22\\\/thushara-matthias-caring-for-older-patients\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2016\\\/11\\\/22\\\/thushara-matthias-caring-for-older-patients\\\/\"},\"author\":{\"name\":\"BMJ\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\"},\"headline\":\"Thushara Matthias: Caring for older patients\",\"datePublished\":\"2016-11-22T14:44:00+00:00\",\"dateModified\":\"2016-11-22T15:18:01+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2016\\\/11\\\/22\\\/thushara-matthias-caring-for-older-patients\\\/\"},\"wordCount\":593,\"commentCount\":1,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#organization\"},\"articleSection\":[\"Guest writers\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2016\\\/11\\\/22\\\/thushara-matthias-caring-for-older-patients\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2016\\\/11\\\/22\\\/thushara-matthias-caring-for-older-patients\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2016\\\/11\\\/22\\\/thushara-matthias-caring-for-older-patients\\\/\",\"name\":\"Thushara Matthias: Caring for older patients - The BMJ\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#website\"},\"datePublished\":\"2016-11-22T14:44:00+00:00\",\"dateModified\":\"2016-11-22T15:18:01+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2016\\\/11\\\/22\\\/thushara-matthias-caring-for-older-patients\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2016\\\/11\\\/22\\\/thushara-matthias-caring-for-older-patients\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2016\\\/11\\\/22\\\/thushara-matthias-caring-for-older-patients\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Thushara Matthias: Caring for older patients\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#website\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/\",\"name\":\"The BMJ\",\"description\":\"Helping doctors make better decisions.\",\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#organization\",\"name\":\"The BMJ\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2018\\\/05\\\/The-BMJ-logo.jpg\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2018\\\/05\\\/The-BMJ-logo.jpg\",\"width\":852,\"height\":568,\"caption\":\"The BMJ\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/logo\\\/image\\\/\"},\"sameAs\":[\"https:\\\/\\\/www.facebook.com\\\/bmjdotcom\\\/\",\"https:\\\/\\\/x.com\\\/bmj_latest\"]},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\",\"name\":\"BMJ\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"url\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"contentUrl\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"caption\":\"BMJ\"},\"sameAs\":[\"https:\\\/\\\/blogs.bmj.com\\\/\"],\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/author\\\/admin\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Thushara Matthias: Caring for older patients - The BMJ","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/blogs.bmj.com\/bmj\/2016\/11\/22\/thushara-matthias-caring-for-older-patients\/","og_locale":"en_US","og_type":"article","og_title":"Thushara Matthias: Caring for older patients - The BMJ","og_description":"I\u2019m 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 [...]More...","og_url":"https:\/\/blogs.bmj.com\/bmj\/2016\/11\/22\/thushara-matthias-caring-for-older-patients\/","og_site_name":"The BMJ","article_publisher":"https:\/\/www.facebook.com\/bmjdotcom\/","article_published_time":"2016-11-22T14:44:00+00:00","article_modified_time":"2016-11-22T15:18:01+00:00","author":"BMJ","twitter_card":"summary_large_image","twitter_creator":"@bmj_latest","twitter_site":"@bmj_latest","twitter_misc":{"Written by":"BMJ","Est. reading time":"3 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/blogs.bmj.com\/bmj\/2016\/11\/22\/thushara-matthias-caring-for-older-patients\/#article","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2016\/11\/22\/thushara-matthias-caring-for-older-patients\/"},"author":{"name":"BMJ","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/person\/ba3da426ed20e8f1d933ca367d8216fe"},"headline":"Thushara Matthias: Caring for older patients","datePublished":"2016-11-22T14:44:00+00:00","dateModified":"2016-11-22T15:18:01+00:00","mainEntityOfPage":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2016\/11\/22\/thushara-matthias-caring-for-older-patients\/"},"wordCount":593,"commentCount":1,"publisher":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#organization"},"articleSection":["Guest writers"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/blogs.bmj.com\/bmj\/2016\/11\/22\/thushara-matthias-caring-for-older-patients\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/blogs.bmj.com\/bmj\/2016\/11\/22\/thushara-matthias-caring-for-older-patients\/","url":"https:\/\/blogs.bmj.com\/bmj\/2016\/11\/22\/thushara-matthias-caring-for-older-patients\/","name":"Thushara Matthias: Caring for older patients - The BMJ","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#website"},"datePublished":"2016-11-22T14:44:00+00:00","dateModified":"2016-11-22T15:18:01+00:00","breadcrumb":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2016\/11\/22\/thushara-matthias-caring-for-older-patients\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/blogs.bmj.com\/bmj\/2016\/11\/22\/thushara-matthias-caring-for-older-patients\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/blogs.bmj.com\/bmj\/2016\/11\/22\/thushara-matthias-caring-for-older-patients\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/blogs.bmj.com\/bmj\/"},{"@type":"ListItem","position":2,"name":"Thushara Matthias: Caring for older patients"}]},{"@type":"WebSite","@id":"https:\/\/blogs.bmj.com\/bmj\/#website","url":"https:\/\/blogs.bmj.com\/bmj\/","name":"The BMJ","description":"Helping doctors make better decisions.","publisher":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/blogs.bmj.com\/bmj\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/blogs.bmj.com\/bmj\/#organization","name":"The BMJ","url":"https:\/\/blogs.bmj.com\/bmj\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/logo\/image\/","url":"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/05\/The-BMJ-logo.jpg","contentUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/05\/The-BMJ-logo.jpg","width":852,"height":568,"caption":"The BMJ"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/logo\/image\/"},"sameAs":["https:\/\/www.facebook.com\/bmjdotcom\/","https:\/\/x.com\/bmj_latest"]},{"@type":"Person","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/person\/ba3da426ed20e8f1d933ca367d8216fe","name":"BMJ","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","caption":"BMJ"},"sameAs":["https:\/\/blogs.bmj.com\/"],"url":"https:\/\/blogs.bmj.com\/bmj\/author\/admin\/"}]}},"_links":{"self":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts\/37823","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/comments?post=37823"}],"version-history":[{"count":0,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts\/37823\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/media?parent=37823"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/categories?post=37823"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/tags?post=37823"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}