Geriatric Care in General Practice

  • Gowrie Pavan


With life expectancy increasing, the workload of the general practitioner will also increase, as more older people seek consultations. The general practitioner is best placed to deliver such care as he or she is often the first person of contact. The demographic characteristics of the oldest old are unique and different to that in the young old people. About a third are aged 75 and above and are among the very high and frequent GP attenders. The forms of preventive care that they provide are immunisation, screening and early identification of chronic conditions such as hypertension, diabetes, cardiovascular and mental health, providing preventative advice, counselling and improving health literacy.


General practitioner Demographic characteristics of the oldest old Preventive health practices Palliative care in general practice Self-care practices End of life Seniors driving 


  1. 1.
    Origins of the general practice of medicine. Accessed 28 Jan 2017.
  2. 2.
    Royal College of General Practitioners. History of the college Accessed 30 Jan 2017.
  3. 3.
    Fisher E. College history. Australian general practice-a celebration. Accessed 30 Jan 2017.
  4. 4.
    General practitioners of Australia. The history of general practice in Australia. Accessed 30 Jan 2017.
  5. 5.
    Foster J, Dale J, Jessopp L. A qualitative study of older people’s views of out of hours service. Br J Gen Pract. 2001;51:719–23.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Tomassini C. The oldest old in Great Britain: change over the last 20 years. Natl Stat Popul Trends. 2006;123:32–9.Google Scholar
  7. 7.
    Topinkova E. Aging disability and frailty. Ann Nutr Metab. 2008;52(Suppl 1):6–11.PubMedGoogle Scholar
  8. 8.
    Charles J, Britt H, Harrison C. General practice workforce and workload. In: Britt H, Moller GC, editors. General practice in Australia, health promotions and policies 1998 to 2008.General practice noGEP24. Canberra: Australian Institute of Health and Welfare; 2009.Google Scholar
  9. 9.
    Britt H, Moller GC, Henderson J, Bayram C, Harrison C, Valenti L, et al. General practices activity in Australia 2014–15. General Practice Series no.38. Sydney: Sydney University Press; 2015.Google Scholar
  10. 10.
    Britt H, Moller GC, Henderson J, Charles J, Valenti L, Harrison C, et al. A decade of Australian general practitioner activity, 2003-04 to 2012-13. BEACH (bettering the evaluation and Care of Health). Sydney: Sydney University Press; 2013.Google Scholar
  11. 11.
    National Health Performance Aurhority (NHPA). Health communities: Frequent GP attenders and their uses of health services in 2012–13. 2015. Accessed 30 Jan 2017.
  12. 12.
    Australian Bureau of Statistics. Patient experiences in Australia: Summary of findings. 2012–13. http:/
  13. 13.
    van Charante EPM, van Steenwijk-Opdam PCE, Bindels PJE. Out-of –hours demand for GP care and emergency services: patients’ choices and referrals by general practitioners and ambulance services. BMC Fam Pract. 2007;8:46. Scholar
  14. 14.
    Campbell SM, Roland MO. Why do people consult the doctor? Family Pract. 1996;3(1). (Oxford University Press; 1996).Google Scholar
  15. 15.
    Haug ML, Folmar ST. Longevity, gender and life quality. J Health Soc Behav. 1986;27:332–5.CrossRefGoogle Scholar
  16. 16.
    RACGP. Acute serious illness and trauma. Accessed 6 Jan 2017.
  17. 17.
    Jones R, White P, Armstrong D, Ashworthy M, Peters M. Managing acute illness. illnesses-gp-inquiry-research-paper-maii.pdf. Accessed 6 Feb 2017.
  18. 18.
    Australian Institute of Health and Welfare (AIHW). Key indicators of progress for chronic disease and associated determinants data report. Cat no. PHE 142. Canberra: AIHW; 2011.Google Scholar
  19. 19.
    Australian Institute of Health and Welfare (AIHW). Australian health 2012. Australia’s health series. no. 13. Cat no. AUS 156. Canberra: AIHW; 2012.Google Scholar
  20. 20.
    Australian Institute of Health and Welfare (AIHW). Australian health 2014. Australia’s health series. no. 14. Cat no. AUS 1578. Canberra: AIHW; 2014.Google Scholar
  21. 21.
    Verbrugge LM. Women and men: Mortality and health of older people. In: Riley MW, Hess RB, Bond K, editors. Aging in Society: Selected reviews of recent research. Hillsdale: Lawrence Eribaum Associates.Google Scholar
  22. 22.
    Basisht G, Singh RH, Chandola H. Management of rheumatoid arthritis (Aamavata) using symbiohealth health care system. Ayu. 2012;33(4):466–74.CrossRefGoogle Scholar
  23. 23.
    Choy E. Understanding the dynamics: pathways involved I the pathogenesis of rheumatoid arthritis. Rheumatology. 2012;51(suppl 5):v3–v11. Scholar
  24. 24.
    Kurko J, Besenyei T, Laki J, Glant TT, Mihecz K, Szekanecz Z. Genetics of rheumatoid arthritis-a comprehensive review. Clin Rev Allergy Immunol. 2013;45(2):170–9.CrossRefGoogle Scholar
  25. 25.
    Kawabata K, Yamamoto K. Recent advances in the pathogenesis of rheumatoid arthritis. Clin Calcium. 2009;19(3):303–9.PubMedGoogle Scholar
  26. 26.
    Jones G. What’s new in osteoarthritis pathogenesis? Intern Med J.
  27. 27.
    Jones G. Sources of pain in osteoarthritis: implications for therapy. Int J Clin Rheumatol. 2013;8:335–46.CrossRefGoogle Scholar
  28. 28.
    Pollard L, Choy EH, Scott DL. The consequences of rheumatoid arthritis: quality of life measures in the individual patient. Clin Exp Rheumatol. 2005;23(suppl 39):S43–52.PubMedGoogle Scholar
  29. 29.
    Lapsley HM, March LM, Tribe KL, Cross MJ, Courtnay BG. Brooks PM for the arthritis cost and outcome project group. Living with rheumatoid arthritis: expenditures health status and social impact on patients. Ann Rheum Dis. 2002;61:818–21.CrossRefGoogle Scholar
  30. 30.
    Tayar JH, Suarez-Almazor M. New understanding and approaches to treatment of rheumatoid arthritis. Br Med Bull. 2010;94(1):201–14.CrossRefGoogle Scholar
  31. 31.
    Agarwal SK. Biologic agents in rheumatoid arthritis: an update for managed care professionals. J Manag Care Pharm. 2011;17(Suppl 11B):S14–8.PubMedGoogle Scholar
  32. 32.
    Suresh E. Recent advances in rheumatoid arthritis. Postgrad Med J. 2010;86(1014):243–50.CrossRefGoogle Scholar
  33. 33.
    Therapeutic guidelines. 2006.Google Scholar
  34. 34.
    Goodwin N, Curry N, Naylor C, Ross S, Duldig W. Managing people with long term conditions. Accessed 5 Feb 2017.
  35. 35.
    Rockwood K, Await E, Macknight C, MDowell I. Incidence and outcomes of diabetes mellitus in elderly eople. Report from the Canadian Study of Health and Aging. CMAJ. 2000;162(6):769–72.PubMedPubMedCentralGoogle Scholar
  36. 36.
    Bloomgarden ZT. Type 2 diabetes in the young. Am Diabetes Assoc Diabetes Care. 2004;27(4):998–1010.CrossRefGoogle Scholar
  37. 37.
    American Diabetes Association. Diagnosis and classification of diabetes. Diabetes Care. 2004;27:S5–S10. DA.CrossRefGoogle Scholar
  38. 38.
    Williamson J, Stokoe IH, Gray S, Fisher M, Smith A, McGhee A, et al. Old people at home. Their unreported needs. Lancet. 1974;1:1117–20.Google Scholar
  39. 39.
    Parsons PL. Mental health of Swansea’s old folk. Br J Psychiatr Soc Med. 1983;19:43–7.Google Scholar
  40. 40.
    Mant A, Eyland EA, Pond CD, Saunders NA, Chancellor AH. Recognition of dementia in general practice. Fam Pract. 1988;5:184–8.CrossRefGoogle Scholar
  41. 41.
    Bowers J, Jorm AF, Henderson S, Harris P. General practitioners detection of depression and dementia in elderly patients. Med J Aust. 1990;153:192–6.PubMedGoogle Scholar
  42. 42.
    Nagaratnam N, Lewis-Jones M. Predictive properties of referral communications for mental illness and dementias in a community. Dement Geriatr Cogn Disord. 1998;9:1117–20.CrossRefGoogle Scholar
  43. 43.
    Brodaty H, Howarth GC, Mant A, Kurrie SE. General practice and dementia. Med J Aust. 1994;160:10–4.PubMedGoogle Scholar
  44. 44.
    O’Connor DN, Pollitt PA, Hyde JB, Brook CP, Reiss BB, Roth M. Do general practitioners miss dementia in the elderly patients? Br Med J. 1988;297:1107–10.CrossRefGoogle Scholar
  45. 45.
    Hickie I, Scott E, Wilhelm K, Brodaty H. Subcortical hyperintensities on magnetic resonance imaging in patients with severe depression-a longitudinal evaluation. Biol Psychiatry. 1997;42:367–74.CrossRefGoogle Scholar
  46. 46.
    Stoppe G, Sandholzer H, Huppertz C, Duwe H, Staedt J. Family physician and the risk of suicide in the depressed elderly. J Affect Disord. 1999;50:193–8.CrossRefGoogle Scholar
  47. 47.
    Bellini M, Matteucci V. Late onset depression and suicide outcome. Arch Gerontol Geriatr. 2001;33:37–40.CrossRefGoogle Scholar
  48. 48.
    Australian Institute of Health and Welfare. Australia’s food and nutrition. Cat. No. PHE163. Canberra: AIHW; 2012.Google Scholar
  49. 49.
    Guidelines for preventive activities in general practice. 8th ed. Melbourne: The Royal Australian College of General Practitioners; 2012.Google Scholar
  50. 50.
    Australian Medical Association (AMA). Doctors and preventative care-2010. Accessed 5 Feb 2017.
  51. 51.
    Woolcock AJ, Bastiampillai SA, Marks GB, Keena VA. The burden of asthma in Australia. Med J Aust. 2001;175:141–5.PubMedGoogle Scholar
  52. 52.
    Senes S, Britt HA. A general practice view of cardiovascular disease and diabetes in Australia. Canberra: Australian Institute of Health and Welfare and University of Sydney, June 2001; Cardiovascular disease. Series No. 18.Google Scholar
  53. 53.
    Department of Health and Aging (DoHA). Enhanced primary care program: overview. Canberra: DoHA; 2008.Google Scholar
  54. 54.
    Health Insurance Commission. Practice incentives program (PIP). Accessed 2 Feb 2017.
  55. 55.
    Health Insurance Commission. Service incentives payments (SIP). Accessed 2 Feb 2017.
  56. 56.
    Blakeman T, Harris MF, Comino E. Implementation of the enhanced primary care items requires ongoing education and evaluation. Aust Fam Physician. 2001;30:75–7.PubMedGoogle Scholar
  57. 57.
    Chan A, Amoros C, Harris M. New 45–49 year health uptake checks: General practitioner uptake of MBS item 717. Aust Fam Physician. 2008;37(9):765–8.PubMedGoogle Scholar
  58. 58.
    Williams I, O’Doherthy L, Mitchell G, Williams K. Identifying unmet needs in older patients: nurse –GP collaboration in general practice. Aust Fam Physician. 2007;36(9):772–6.PubMedGoogle Scholar
  59. 59.
    Mitchell GK, de Jong IC, Del Mar CB, et al. General practitioner attitudes to case conferences: how can we increase participation and effectiveness? Med J Aust. 2002;177:95–7.PubMedGoogle Scholar
  60. 60.
    Hinton J. Can home care maintain a acceptable quality of life for patients with terminal cancer and their relatives? Palliat Med. 1994;8:183–96.CrossRefGoogle Scholar
  61. 61.
    Barclay S, Wyatt P, Shore S, Fnlay I, Grande G, Todd C. Caring for the dying: how well are general practitioners? A Questionnaire study in Wales. Palliat Med. 2003;17(1):27–39.CrossRefGoogle Scholar
  62. 62.
    Mitchell GK. How well do general practitioners deliver palliative care? A systematic review. Palliat Med. 2002;16(6):457–64.CrossRefGoogle Scholar
  63. 63.
    MacKichan F, Paterson C, Henley WE, Britten N. Self-care in people with long term health problems: community based survey. BMC Fam Pract. 2011.
  64. 64.
    Colman MT, Newton KS. Supporting self-management in patients with chronic illness. Am Fam Physician. 2005;72(8):1503–10.Google Scholar
  65. 65.
    Novak M, Costantini L, Schneider S, Beanlands H. Approaches to self-management in chronic illness. Semin Dial. 2013;26(2):188–94.CrossRefGoogle Scholar
  66. 66.
    Newman S, Steed L, Mulligan K. Self-management interventions for chronic illness. Lancet. 2004;364(9444):1523–37.CrossRefGoogle Scholar
  67. 67.
    Franek J. Self-management support interventions for persons with chronic disease: an evidence –based analysis. Ont Health Technol Assess Ser. 2013;13(9):1–60.PubMedPubMedCentralGoogle Scholar
  68. 68.
    Greaves CJ, Campbell JL. Supporting self-care in general practice. Br J Gen Pract. 2007;57(543):814–21.PubMedPubMedCentralGoogle Scholar
  69. 69.
    Department of Health. The NHS plan: a plan for investment and plan for reform. London: Department of Health Publications; 2000.Google Scholar
  70. 70.
    Department of Health. Public attitudes to self-care –baseline survey. London: Department of Health Publications; 2005.Google Scholar
  71. 71.
    Blakeman T, Macdonald N, Bower P, Gately C. A qualitative study of general practitioner’s attitudes to self-management of chronic disease. Br J Gen Pract. 2006;5(527):407–44.Google Scholar
  72. 72.
    Morrel DC, Wale CJ. Symptoms perceived and recorded by patients. J R Coll Gen Pract. 1976;26:398–403.Google Scholar
  73. 73.
    Jordan JE, Briggs AM, Brand CA, Osborne RH. Enhancing patient engagement in chronic disease self-management support initiatives in Australia: the need for an integrated approach. Med J Aust. 2008;189(10Suppl):S9–S13.PubMedGoogle Scholar
  74. 74.
    Harris ME, Williams AM, Dennis SM, Zwar NA, Powell Davies G. Chronic disease self-management: implementation with and within Australian general practice. Med J Aust. 2008;189(10 Suppl):S17–20.PubMedGoogle Scholar
  75. 75.
    Reed RL. Models of general practitioner services in residential aged care facilities. Accessed 6 Feb 2017.
  76. 76.
    O’Halloran J, Britt H, Valenti L. General practitioner consultations at residential aged-care facilities. Med J Aust. 2007;187:88–91.PubMedGoogle Scholar
  77. 77.
    Hambleton S. Aged care: three areas in need of support. Financ Rev 2. April 2014.Google Scholar
  78. 78.
    Australian Aged Care Quality Agency. More collaboration between GPs and RACFs. Accessed 5 Feb 2017.
  79. 79.
    Centers for Disease Control and Prevention, National Center for Injury prevention and Control. Web-based injury statistics query and reporting system (WISQARS). Atlanta, GA: CDC;2016 [cited 2016 Dec 21].
  80. 80.
    National Highway Traffic Safety Administration, Department of Transportation (US). Traffic safety facts 2014: older population. Washington(DC): NHTSA; 2016.Google Scholar
  81. 81.
    van den Berg TJ, René van Rijn LJ, Kaper-Bongers R, Vonhoff DJ, Volker-Dieben HJ, Grabner G, et al. Disability glare in the aging eye. Assessment and impact on driving. J Optom. 2009;02(03):112–8.CrossRefGoogle Scholar
  82. 82.
    Salvi SM, Aktar S, Currie Z. Ageing changes in the elderly. Postgrad Med J. 2006;82:581–7.CrossRefGoogle Scholar
  83. 83.
    Murman DL. The impact of age on cognition. Semin Hear. 2015;36(3):111–21.CrossRefGoogle Scholar
  84. 84.
    Glisky EL. Chapter1: Changes in cognitive function in human aging. Riddle DR Brain aging: models, methods and mechanisms. Boca Raton :CRC Press/Taylor &Francis; 2007.Google Scholar
  85. 85.
    Seidler RD, Bernard JA, Burutolu TB, Fling BW, Gordon MT, Gwin JT, et al. Motor control and aging: links to age-related brain structural, functional and biochemical effects. Neurosci Biobehav Rev. 2010;34(5):721–33.CrossRefGoogle Scholar
  86. 86.
    Jevas S, Yan JH. The effect of ageing on cognitive function: a preliminary quantative review. Res Q Exerc Sport. 2001;72:A-49.Google Scholar
  87. 87.
    Luchies CW, Schiffman J, Richards LG, Thompson MR, Bazuin D, De Young AJ. Effects of age step direction, reaction condition on ability to step quickly. J Gerontol A Biol Sci Med. 2002;57(4):M248–9.CrossRefGoogle Scholar
  88. 88.
    O’Dell M, Charlton J, Koppel S. Assessing fitness to drive. Australian
  89. 89.
    Berry C. Older drivers and behavioural change. An ILC-UK policy brief. Nov. 2011.

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Gowrie Pavan
    • 1
  1. 1.Family Medical PracticeCarlingfordAustralia

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