The sensible precaution of making a living will or an advanced directive means that doctors need not struggle to keep alive those who feel it is time to move on. Now doctors in Scotland, as reported in this paper last week, have extended this principle to “inappropriate” hospitalisation. This is a particular hazard for the frail and elderly in residential care or living at home. Their condition deteriorates, an ambulance is summoned, and they end up in hospital receiving what is euphemistically called PIC, or potentially ineffective care.

The way around this is the drawing up of an anticipatory care plan that specifies what should occur in such a situation. The results have been most encouraging, with a fall in the number of unplanned hospital admissions by almost a half, and substantial financial savings. This seems to be an excellent proposal, while at the same time – as the doctors involved put it in their customarily long-winded way – it “increases patient autonomy and inclusion in the decision-making process”.

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It is always gratifying to hear from those whose lives may have been touched for the better by some items in this column – such as the observation last year that Viagra, along with its better-known effects, can also usefully alleviate the shaking hands of those with benign essential tremor. “I, too, can report a positive effect,” writes a 76-year-old reader from California. “I can now sign my name again and drink soup; the difficulty I previously had with these two tasks was very tiresome.”

The often fortuitous discovery that a drug used for one condition turns out to be beneficial for another is now known as “repurposing”, and should, it is suggested, be pursued more systematically.

SOURCE:http://www.telegraph.co.uk/health/elderhealth/9044359/Keeping-the-elderly-out-of-hospital.html