Patient stories – subacute care
Geriatric management and evaluation
Greg is 79 years old, and has a number of complex conditions associated with ageing.
He was admitted to a major metropolitan hospital with breathing difficulties.
Managing complex medical conditions
While in the hospital, he was also found to be suffering from a urinary tract infection.
After he was stabilised, he was transferred to a geriatric management and evaluation unit within the hospital.
His complex conditions were reviewed, treated and managed by a geriatrician and other health professionals, including:
- physiotherapist
- occupational therapist
- dietitian
- social worker.
Once he improved, he was able to return home with a follow-up plan to help him remain independently at home.
Falls rehabilitation
Marie is 77 years old, and has experienced a number of falls at home.
Exercises help to improve balance and reduce the risk of falls
Her doctor referred her to a day therapy unit at her local hospital for assessment and treatment.
Her assessment revealed Marie had low blood pressure which may have attributed to her recent falls.
Once this was reviewed and managed by the geriatrician, she was prescribed exercises by a falls specialist physiotherapist to improve her poor balance.
This has reduced her risk of further falls and has helped to keep her out of hospital.
Stroke rehabilitation
Jane is 33 years old and was admitted to hospital after having a stroke.
After receiving medical care to stabilise the stroke, she was transferred to a rehabilitation unit near her home.
Her speech was impaired and her left side was weak.
She received intensive rehabilitation therapy from specialists in stroke rehabilitation, including:
- physiotherapist
- occupational therapist
- speech therapist.
Soon after, she was able to return home.
She was also referred to an outpatient stroke clinic near her home for ongoing care and monitoring.
Psychogeriatric care
George is retired and lives in a country town.
Upper limb retraining
His wife Mary’s mental state had been deteriorating over the last 3 years.
He began to find it difficult to look after her as she wandered off and sometimes became aggressive.
Sometimes Mary’s wandering behaviour caused George to worry about her safety and he was unsure how to look after her.
He discussed Mary’s options with his GP who referred George and Mary (with their consent) to the visiting geriatrician.
The geriatrician, who visited the town hospital once a month, provided advice on how George could look after Mary.
He also carried out a thorough assessment and diagnosed Mary with severe dementia.
He made sure her medications would not exacerbate it further.
After discussions with George, a 10-day respite care at a dementia specific hostel was arranged for Mary.
This enabled George to take a much needed break while longer term plans were investigated.
The geriatrician considered George’s increasing difficulty in caring for Mary and the limited support available.
He discussed options for Mary’s long-term care needs, including a dementia specific aged care facility.
This facility was able to offer Mary the support she needed.
It also provided George with the reassurance that she would be safe.
With George’s agreement, a bed was found for Mary in the facility.
He was able to start looking after himself more, and visit Mary daily.
Where to get help
Acknowledgements
Aged and Continuing Care Directorate
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