The importance of a comprehensive geriatric assessment for older people admitted onto a virtual ward
A comprehensive geriatric assessment (CGA) provides a holistic assessment for the frail and older person. The CGA considers physical and mental conditions as well as function, environmental and a person's social circumstances. Virtual wards are a new concept within the NHS, and use of virtual wards during the COVID-19 pandemic reduced hospital admissions by 50%. The British Geriatrics Society has set clear guidelines on how virtual wards should be developed within integrated care services via multidisciplinary community rapid response teams to improve patient outcomes. This article considers a logical approach to assessing suitability for admission onto a virtual ward for a patient who required hospital-at-home services. It does this through the use of a theoretical patient case study, in this case involving delirium and urinary tract infection. Frailty and frailty scoring tools are discussed, as are the advantages and disadvantages of a CGA, considering a clear progression through the five domains. It shows how conducting a CGA allows for the development of a problem list to help prioritise the patient's problems and plan accordingly. A critical review of the literature around virtual wards, hospital-at-home services and admission avoidance identified that community rapid response teams were the logical choice to provide a multidisciplinary holistic approach to the older person admitted onto a virtual ward.
The purpose of completing a comprehensive geriatric assessment (CGA) is to provide a holistic assessment of patients who are frail or are vulnerable adults, in order to deliver measurable health improvements to the older person and reduce hospital admissions (Welsh et al, 2014). In an ever-ageing population – with currently over 12 million people in the UK over the age of 65 and close to 15 000 aged over 100 – the need for CGAs has never been greater (Welsh et al, 2014; Age UK, 2019; Office for National Statistics, 2019).
Virtual wards are a relatively new approach in health care and there has been a drive for these in the NHS in England since the COVID-19 pandemic (NHS England, 2022a). COVID-19 virtual wards showed that they could be implemented safely and quickly while reducing hospital admissions by up to 50% (Thornton, 2020; NHS England Transformation Directorate, 2023). Recent pressures to develop transformational change within the NHS have led to the development of virtual wards or ‘hospital at home’ services for frail older people and people with long-term health conditions (British Geriatrics Society, 2022).
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