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Should physicians be routinely involved in the care of elderly surgical patients? No

BMJ 2011; 342 doi: (Published 04 March 2011) Cite this as: BMJ 2011;342:d1072
  1. Barbara Herd, consultant physician medicine and elderly care
  1. 1 University Hospital of North Tees, Stockton on Tees TS19 8PE, UK
  1. barbara.herd{at}

Standards of care for elderly people in hospital have come under the spotlight. Kathy Wilkinson and Helen Wilson (doi:10.1136/bmj.d1070) believe that geriatricians can help improve the management of surgical patients, but Barbara Herd is concerned that the dilution of resources will harm those who most need specialist attention

The recent National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report, An Age Old Problem, found serious shortfalls in the care of some elderly surgical patients.1 However, the report looked at a small sample of total surgical activity with no examination of the vast majority of cases where things went right. Only 786 of the 1756 cases could be fully analysed, and 295 were judged to have elements of substandard care. About a third were patients with fractured neck of femur, who can be considered separately. The response to the report should be proportional. Bad care is bad care, but many of the examples of substandard care are not specifically relevant to older patients—poor monitoring, poor assessment of nutrition and pain, and poor management of fluids are not acceptable at any age.

The British Geriatric Society remains cautious about the way forward, …

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