Dr. Colm Henry:

It is a very apt comment about older people. Previous speakers have alluded not just to demographic change but to the fact that in the past ten years people are surviving to a greater extent from interventions on heart disease, stroke and cancer than we could have imagined even a short time ago in medical terms. This winter we saw that the rate at which those over 75 were presenting was up December on December by 13%, which is much more than could be explained by demographics. It is a reflection of people surviving with chronic disease. By the time they come to an emergency department, the chances are they will have to be admitted. Our focus cannot just be on building hospital capacity to deal with older people who need hospital care but on shifting care into the community.

There are a number of initiatives and Dr. O'Conor alluded to this in terms of Connolly Hospital and the Mater where geriatricians appointed both to the hospitals and the community succeeded in reducing the number of patients referred from nursing homes to emergency departments at a time when the nursing home population expanded in the catchment. We are expanding this to seven other sites nationally. It means dehospitalising the care of older people where one can and an earlier alert system for those who are sick in order that they can be seen in another environment such as a day hospital. It also means interventions which can be targeted long before people get so sick that they have to come to an emergency department. As I said, by the time an old person with a chronic disease comes to an emergency department, it is likely he or she will need to be admitted regardless of whether a senior decision-maker is there.