Kingston Hospital NHS Foundation Trust, London, UK
King's College London, London, UK.
Clin Med (Lond). 2018 Oct;18(5):374-379. doi: 10.7861/clinmedicine.18-5-374.
There is increasing recognition that the ageing population represents a challenge to existing surgical services. National reports recommend that geriatricians proactively review older surgical patients to improve care and outcomes. However, this approach has not been widely translated into practice. A qualitative study was conducted using 12 semi-structured interviews of surgeons and geriatricians to explore the role of the geriatrician in the care of older surgical patients. Participants agreed that the current system did not meet the needs of older surgical patients. Geriatricians valued their holistic way of working but these generalist skills can overlap with other specialties, seen by some as wasting resources. Three models of care were proposed, with the ownership and location of the patient as well as the role of education being the key variables. The main obstacle preventing integrated working was the concern of de-skilling the surgeons, narrowing their role to that of a 'technician'. Other barriers included loss of autonomy; lack of evidence; and a lack of recognition of the need for a geriatrician. There is acceptance that closer working practices are necessary to meet the needs of this complex patient group but a lack of evidence, together with significant human factors, are challenges that must be addressed to realise this aim.
人们越来越认识到，人口老龄化对现有外科服务构成挑战。国家报告建议老年病医生主动审查老年外科患者，以改善护理和预后。然而，这种方法尚未广泛转化为实践。本研究采用 12 名外科医生和老年病医生的半结构式访谈进行了定性研究，以探讨老年病医生在老年外科患者护理中的作用。参与者一致认为，目前的系统不能满足老年外科患者的需求。老年病医生重视他们全面的工作方式，但这些通才技能可能与其他专业重叠，一些人认为这是浪费资源。提出了三种护理模式，患者的所有权和位置以及教育的角色是关键变量。阻碍综合工作的主要障碍是担心外科医生技能下降，将其角色缩小为“技术人员”。其他障碍包括自主权丧失；缺乏证据；以及对老年病医生需求的认识不足。人们已经认识到，需要更紧密的工作实践来满足这一复杂患者群体的需求，但缺乏证据以及重大的人为因素是实现这一目标必须解决的挑战。
