Routine chest radiography is common practice in geriatric admission units. The cumulative cost of this unproven procedure is very high, and the authors challenge the need to carry out the investigation in all cases. A prospective survey of 1000 consecutive admissions to an acute geriatric ward showed that 35-50% had little or no clinical indication for chest X-ray examination, and that omitting the investigation in these patients would not have resulted in 'missed' significant chest conditions. Considerable savings to the service would accrue if radiology was restricted to those patients with a positive indication for the investigation.
The endoscopic experience involving the study of 114 patients in the geriatric age group (65-89 years) in a district general hospital is described. The cases examined were mainly patients with dyspepsia, gastrointestinal blood loss, suspected upper alimentary tract carcinoma or those who had undergone gastric surgery. The procedure was well tolerated and safe. Useful information was obtained in the majority of patients (93 per cent). When the endoscopic and radiological findings were compared the endoscopist and radiologist were in agreement in 55 per cent of the cases examined by both techniques. In the others endoscopy played an essential role in establishing the presence of radiologically undetected or undetectable disease, and in confirming or excluding radiologically doubtful disease.
Over-prescribing on long-stay wards for the elderly is a common problem. A scheme of senior doctor surveillance of prescribing on long-stay wards in a district general hospital is described, which involved stopping all drugs except those considered essential. A reduction of over 50% in the number of drugs taken per patient, and a saving of 34% in drug costs was achieved, without detriment to patients' well-being. Increased drug utilization on some wards is considered to occur because of the ward sister's demand for patients to be given drugs such as sedatives and tranquilizers. Regular re-education of nursing and junior medical staff to reduce over-prescribing is recommended.
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