How can I implement a multidisciplinary approach to address geriatric syndromes in my practice?

To implement a multidisciplinary approach to address geriatric syndromes in your clinical practice, establish a multidisciplinary team (MDT) including doctors, nurses, therapists, mental health practitioners, pharmacists, dietitians, specialists relevant to the patient's conditions, social workers, housing specialists, and voluntary sector practitioners to provide coordinated care ³.

Start comprehensive assessments of older people with complex needs at the point of admission or first contact, ideally in a specialist geriatric unit or setting, to identify health and social care needs ³.

Develop individualised management plans based on personalised assessments that consider multimorbidity, frailty, patient goals, preferences, and treatment burden to improve quality of life and reduce adverse events ².

Coordinate care across settings by ensuring communication and information sharing between hospital-based and community-based MDTs, using accessible electronic data systems while respecting information governance ³.

Assign a named discharge coordinator or care coordinator responsible for managing transitions between care settings and acting as a central contact for the patient, family, and healthcare professionals ³.

Implement multifactorial interventions for common geriatric syndromes such as falls, including strength and balance training, home hazard assessments with follow-up interventions, vision assessments, and medication reviews with specialist input to reduce risks ¹.

Review medications regularly, especially psychotropic drugs, to minimise risks such as falls and adverse drug interactions, particularly in patients with multimorbidity and polypharmacy ¹,².

Encourage patient participation by discussing willingness to make changes and providing information in accessible formats and languages ¹.