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01 October 2019

Launch of RACGP’s resource for caring for older people

To coincide with the International Day of Older Persons the Royal Australian College of General Practitioners (RACGP) has launched the fifth edition of the Silver Book - a go to guide for the complex clinic care of older people.

First developed more than 20 years ago as a brief manual of 17 pages, the Silver Book is one of the RACGP’s flagship clinical resources.

The fifth edition of the Silver Book, which will be re-titled RACGP aged care clinical guide (Silver Book), is significantly expanded from previous editions in scope and content.

RACGP President Dr Harry Nespolon said that the Silver Book was being released at a critical time.

“The Royal Commission into Aged Care Quality Safety emphasised the complex and challenging nature of providing clinical care for older people.

“The proportion of Australians aged 65 years and older is growing, in fact it is projected to more than double in coming years.

“The Silver Book states that more than one in three GP–patient encounters are with people in this cohort and GPs are only going to see more and more older people in their practices and in residential facilities.

“This does present challenges for GPs but we can also see it is an opportunity. Consider the Silver Book a road map guiding Australian GPs so that they can set the world standard and help older people get the care and support that is right for them.

“We need to have up-to-date, evidence-based practice points on screening, diagnosis, management and treatment. Getting this right it will make a massive difference in the lives of older people.”

Dr Nespolon said that GPs were on the frontline when it came to providing clinical care for older Australians.

“As things stand there is no aged care clinical guide for the primary care of patients in the aged care sector; that includes residential aged care facilities and in the community.

“That is a problem, you only need to look at the recent release of our General Practice: Health of the Nation report which found that in 2018-19 alone GPs provided over 5.5 million Medicare services in residential aged care facilities.

“That means some 14% of GPs had worked in these facilities providing crucial care to older people, many of whom have multiple medical conditions. That report emphasised that a lot of this work goes unremunerated but it is absolutely essential.”

Associate Professor Mortin Rawlin, who is chairing the RACGP’s review of the resource, said that Silver Book would make a real difference in patient care.

“Caring for older people is complex and let’s remember that a GP may be looking after a patient for many decades.

“The patient’s usual GP will know their full clinical history, including their life experiences outside of the consultation room.

“One of the key challenges GPs face is collaborating with any given patient’s broader multidisciplinary healthcare team. This may include carers, nurses, other specialist medical practitioners or allied health professionals.”

A/Prof Rawlin noted that ensuring the highest standard of care doesn’t necessarily always mean doing more.

“For example, one section of the Silver Book examines deprescribing, which involves reassessing the role of all medicines being taken with a view to stopping the use of those that may cause harm or no longer fit with the current goals of care.

“It’s all about focussing on the individual needs of the patient to achieve the highest quality of care possible.”

Other key “practice points” to guide GPs include:

  • multimorbidity, which includes guidance on conducting a comprehensive search of a patient’s electronic medical records
  • palliative and end-of-life care, which covers practices such as recognising escalating palliative care needs at major transition points
  • medication management
  • mental health such as the management of loss and grief to prevent older people from developing depression
  • behavioural and psychological symptoms of dementia.

You can find the Silver Book at: https://www.racgp.org.au/silverbook

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