‘Health MOTs’ planned for people aged 65 and over arriving at emergency departments in England

People aged 65 and over who arrive at A&E in England and appear frail will soon receive a “health MOT at the front door”, the head of the NHS has promised.

A&E departments should start by giving everyone of that age a series of tests to see if they are frail or have another underlying condition, and then arrange the care they need.

NHS England hopes the initiative will reduce the number of older people admitted to hospitals and reduce overcrowding, “trolley waiting” and “corridor care”.

Amanda Pritchard, the organisation’s chief executive, will tell an audience of health chiefs on Wednesday that they must ensure all A&E units are offering detailed assessments of the health of older people by April next year. However, the service will only operate 10 hours per day.

“Health MOTs at the front door of the emergency department for the elderly can be a lifeline for many. From blood pressure tests to a review of their falls history, these checks ensure patients can be quickly assessed and referred to the right support for their needs,” says Pritchard.

“Although some people require admission, this is not always the most appropriate location for the needs of older patients, and they can also quickly lose mobility during their hospital stay.”

The initiative is an attempt by the NHS to change the way care is delivered to ease pressure on hospitals and adapt to the increasing demands of an aging population.

Assessing frailty is important because falls and resulting injuries, such as fractures, are one of the most common reasons for many older people to spend time in hospital.

“Half of hospital patients over the age of 65 are affected by frailty, and the growing number of people with frailty will have a significant impact on future health and care services,” said Sir Julian Hartley, the CEO of NHS Providers.

Despite some hospital and community services providing innovative care for such people, “too many vulnerable people who need well-planned, collaborative care are still not getting the support they need,” Hartley added.

The checks will also test older patients’ heart health, mobility, risk of malnutrition and any history of breathing problems. Anyone at risk of a fall will be referred to the hospital’s falls service, while people with other needs will receive care from specialist teams, such as those who care for people with dementia.

More than a million people over the age of 75 are admitted to hospital in England every year and around one in five are seriously vulnerable. Doctors are concerned that older patients undergo ‘deconditioning’ during their hospital stay and lose muscle mass, which can increase the risk of falling and being readmitted to hospital shortly afterwards.

Some hospitals are already giving older patients the “APKs” that will become standard next spring.

For example, the acute frailty assessment unit at the Princess Royal Hospital in Orpington, Kent, now gives a frailty score to more than nine in ten admitted patients aged 65 or over. That helped the hospital get more patients home sooner and double the number of patients discharged home within a week.

A clinical nurse specialist in the emergency department identifies vulnerable older people, while the frailty team works closely with the London Ambulance Service, community health services and local GPs.

However, emergency doctors warned that the checks could obscure what they believe are the real reasons why so many people end up in emergency rooms and often have to wait long periods for treatment.

“Focusing on these types of interventions diverts attention from the root causes of long emergency room wait times. These include a lack of staffed beds and difficulties in discharging patients because social care and community services are in such difficulty,” said Dr Ian Higginson, the vice-president of the Royal College of Emergency Medicine.

“Unless these fundamental issues are addressed, we will continue to see long wait times in our emergency departments, resulting in patients continuing to suffer harm.” There was no evidence that vulnerable patients contributed to emergency room overcrowding, he added.