Many of you may have been tasked with the request to “take a collateral.” What does this mean? The heart of acute geriatrics is about gaps in function, and sometimes the patient isn’t able to tell us so we need to find out from somewhere else.
What is your patient like normally? How are they now? And what are the reasons for this?
Firstly, always take a collateral history. It’s deeply distressing to see that a patient has been in hospital for hours, maybe days, with pages and pages of writing and yet it’s impossible to see anywhere what the patient is normally like, or what has happened. A clerking that says “Confused ?more than normal” isn’t good enough!
So pick up the phone and contact a relative/friend/neighbour/caregiver. If they are from a care home you could do this any time of day or night.
Rant over. Here’s what to cover…
When were they last well? Most acute illnesses are days to a few weeks. If you are struggling to get an answer, try asking what the patient was like two weeks ago
When they are well…
How do they walk? Aids? How far? Can they manage stairs?
Do they leave the house? When did they last leave the house?
Can they wash and dress themselves? Can they toilet themselves? Are they continent?
Cook? Clean? Shop? Manage the bills? If someone used to be able to cook a meal and plan the weekly shop and manage their finances but no longer can, this is a clue to worsening cognition and further questions need to be asked.
Where do they live? (House/bungalow/flat/care home) Steps into property or in property?
Who do they live with?
Any formal carers?
Any informal support – family/friends/neighbours?
Occupation? Previous and current hobbies? Nice to build up a picture of the person and a good way to chat and build rapport on ward rounds
Any family concerns – better to address these early on than everyone being upset on the planned day of discharge
Power of Attorney – for health? Finances?
Taking a clear collateral history is one of the most valuable things you can do in geriatric medicine. When I’m dealing with a patient recovering from pneumonia who needs two staff to transfer out of bed, it matters a lot whether this is normal for the patient or whether they normally walk independently.
Bridging this gap involves treating acute medical issues, addressing polypharmacy, ensuring patients aren’t constipated or in retention, treating pain, addressing mood and cognition, providing rehabilitation and addressing their environment – a little more than “MFFD, PT/OT” – and what we call comprehensive geriatric assessment.
We cover a lot of the how to do this in my 21 tips…