Poor inpatient care for older people

In 1963, in a message to Congress, John F Kennedy said that a society’s quality and durability can best be measured by the respect and care given to its elderly citizens.1 By this measure, the recent report from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) on the perioperative care of older people gives our society cause for concern.2 The report has been widely received as demonstrating inadequate care for older people undergoing surgery, and its findings described as shocking, disturbing, and unacceptable⇓.3

The report describes an observational study of more than 800 patients over the age of 80 years who died within 30 days of a variety of surgical procedures. There was nothing extraordinary about these patients—they were typical in many ways of the population accessing acute care in the modern NHS. They were older; nearly all had comorbidity (94%); disabilities were common, as was delirium or dementia, or both; and many (66%) were identifiably frail. A key finding was that only …