Elderly Medicine

Inpatient Services

The department of medicine for the elderly is the largest department within the medical division and is housed in a new, purpose built unit next to the main corridor at the University Hospital Aintree site. The department provides in-patient, outpatient, and day treatment services.   The department also has general internal medicine inpatient beds and runs general medical outpatient clinics.   The prosthetic and wheelchair centre whilst functioning independently is part of the department.

In-patient acute care for older patients deals especially with patients who have multiple and complex problems, for example, patients with falls, immobility and confusion.   It provides rehabilitation for those patients whose illness leads to functional deterioration with the goal of achieving independent living at home again.

The department has seven consultants plus one community geriatrician and one consultant in rehabilitation medicine. There is junior doctor support and nursing staff with general and specialist expertise. Occupational and physiotherapy services support the department as do colleagues from speech and language therapy and dietetics.   We have a specialist nurse for stroke who facilitates the stroke patient from admission to discharge and post discharge, ensuring comprehensive assessment and implementation of stroke care. co - ordinates rapid access stroke clinics   and one for continence assessment and treatment who provides a trust wide service. The department has support from mental health liaison nurses and the clinical psychology department provides a clinical service for stroke patients.

Within the department we have developed areas of specialist interest for those medical problems afflicting older people.

The Stroke Unit was established 15 years ago and is recognised nationally.   Stroke patients are admitted, as far as possible, directly to the Stroke Unit by a fast track process and all eligible patients are given the benefit of Thrombolytic treatment and other acute interventions as part of established protocols. The 3 Stroke physicians provide an on-call service along with the 3 Stroke Nurse Clinicians. The Stroke unit has 29 beds which include separate acute male and female bays which have monitoring facilities. Stroke rehabilitation takes place from admission and the multidisciplinary team works closely with the community based early supported discharge team. Patients are followed up in the stroke review clinic after discharge to ensure secondary prevention treatments are in place and to review ongoing problems.   The stroke physicians also run rapid access stroke clinics , so that rapid interventions can take place for TIA or “mini-stroke” patients to avoid developing a stroke.

The department provides a daily orthogeriatric liaison service to the orthopaedic wards with multidisciplinary discharge planning. We have a specialist orthogeriatric rehabilitation service which is under development to accept hip fracture patients much earlier in their hospital admission.   Orthogeriatric follow-up clinics take place to support adequate recovery and secondary preventative measures.

We have several rehabilitation beds devoted to amputee rehabilitation under the supervision of a consultant in rehabilitation medicine from the prosethetic and wheelchair department.

Our department runs metabolic bone disease clinics for adults of all ages. The commonest condition seen is osteoporosis (thinning of bones), which increases the risk of fractures. We also run AFRI (Aintree Fracture Reduction Initiative) in which we screen all patients over the age of 45 attending fracture clinic and if appropriate offer them DEXA bone density measurement as a part of osteoporosis assessment. Depending on the results, appropriate life style changes and treatment is advised through a Nurse Led Clinic.   The clinic also sees and treats patients with Paget’s disease and other metabolic bone diseases.   Intravenous treatments for metabolic bone diseases are provided by the nurses in the assessment and rehabilitation unit.

We run a falls clinic each week where fallers or patients at high risk of falls can be seen for medical and multidisciplinary assessments.

ARDU

The assessment and rehabilitation day unit (ARDU) formerly the Geoffrey Murray Day Hospital provides a large variety of services for older patients.   The specialist clinics provided in the ARDU are listed below.

In addition, there are 40 places for medical and rehabilitation assessments per week in the ARDU.   Intravenous treatments for metabolic bone disease are provided daily as are specialist treatments for leg ulceration. Attendees even have access to alternative therapies such as Tai Chi and Reiki.

Rapid Referral Stroke Clinic

These are held three times a week, on Monday and Wednesday afternoons and Friday mornings. These make it possible to see people who are suspected of having a TIA/stroke within 48 hours of them being referred to us. This is a one-stop clinic with the patient being assessed by the Stroke Physician and subsequently undergoing radiology and pathology investigations as well as initiation of a treatment plan and further referral being done on the same day.

Stroke Review Clinic

These are held once a week on Tuesday afternoons. This is a multi disciplinary clinic and includes participation from Stroke Physicians, Specialist nurses, Physiotherapist, Occupational therapist, Clinical Psychologist and Stroke Association Family support worker.

Metabolic Bone Disease Clinic

These deal with general disorders of the bones and are held on Monday mornings and Wednesday afternoons.

Nurse Led Fragility Fracture Clinic

These clinics deal with people over the age of 45 who have suffered fractures after a low trauma fall. They are held once a week on Thursday afternoon.

Orthogeriatric Clinic

The orthogeriatric clinic is a follow-up service for hip fracture patients with impaired mobility and falls risk.   It ensures secondary prevention measures for falls and fractures are in place and assesses on going rehabilitation needs.

Falls Clinic

These clinics provide comprehensive assessment for older people who fell and/or at high risk of falling. They are held once a week on Thursday.

General Internal Medicine

Each consultant geriatrician also looks after general medical patients.   We have 28 acute medical beds for medical patients who cannot easily be triaged into specialist medical services.   Each consultant runs a weekly general medical clinic which sees young and old patients with a wide variety of medical problems.

Prosthetic and Wheelchair Centre

We also provide a high quality prosthetic (false limb) and wheelchair service.   The Centre provided a Supra-District Artificial Limb, Wheelchair and Special seating service for patients, of all ages.   The ethos of the Centre is to encourage users to progress through the rehabilitation process efficiently and effectively in a friendly and caring atmosphere, considering the users individual needs and using a holistic approach.

A Multi-disciplinary team led by the Consultant in Rehabilitation Medicine caters for the rehabilitation needs of amputees and people with permanent mobility problems.   The team includes Occupational Therapists, Physiotherapists, Rehabilitation Engineers, Prosthetists, Technicians, Orthotists, Psychologist, Chiropodist, Nurses and Administration staff.  

The patients are usually “patients for life” and once they are initially referred by a health care professional, they can contact the Centre at any time.

We have several information leaflets available for patients in the Directorate and hold a variety of meetings throughout the year, to ensure current and former patients have the opportunity to make their views on their treatment known to staff. These meetings include the monthly Stroke Carers Group, Falls Steering Group and the National Service Framework Committee where patients have the opportunity to discuss current Government guidelines and whether they feel we are meeting them. There are also monthly meetings for wheelchair users linked to the hospital.

We work closely with health professionals in the community, particularly in relation to patients who have had falls or strokes.

We are always looking   to expand and improve our services and over the coming months we will be increasing the number of beds on the rehabilitation ward for patients who have had hip fractures, so they can have access to the best care and treatment to ensure they are safe to be discharged.

If you would like more information about the work of this department, please contact clinical business manager Susan Connor on 0151 529 8792 or Ann Douglas, clinical office manager, 0151 529 3655.