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Care of the highest quality – regardless of where they live

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In order to coincide with the International Day of Older Persons, the RACGP Silver Book Expert Advisory Group (EAG) is pleased to present the new edition of the RACGP aged care clinical guide (Silver Book) to the general practice profession.
 
Over the years, many general practice registrars and practising GPs have used the Silver Book as the go-to guide for the complex clinical care of older people.
 
The Silver Book was first developed more than 20 years ago as a brief manual of 17 pages, and while the resource doubled in size from the third to fourth editions in 2006, much of the content has since become obsolete.
 
As GPs, the clinical care of older people should be part of the continuity of care provided to the practice’s patient population. This is particularly important, as the number of Australians aged 65 years and older will more than double in coming years – GPs will increasingly see more of these patients in their practice and residential aged care facilities.
 
As all GPs with older patients will understand, the care of these patients is often complex and the challenge is to provide appropriate care of the highest quality, regardless of where they live.
 
Recognising the central role that GPs play in the clinical care of older people, the RACGP Board in early 2018 tasked myself (as Chair) and the EAG with writing, reviewing and updating the Silver Book to ensure it remains relevant and useful to the general practice profession. The EAG has spent the past 22 months ensuring the update comprises up-to-date, evidence-based practice points on screening, diagnosis, management and treatment on a range of common, challenging clinical conditions in Australian aged care.
 
I gratefully acknowledge the authors, editors, reviewers and representatives from the organisations who contributed scholarly feedback for this new edition and the previous four editions of the Silver Book. The fifth edition builds on the foundation set by the previous four editions and will be retitled  to reflect the increasing prevalence of older people choosing to live their old age in the community, or remaining in the community for longer.
 
This new edition has been significantly expanded, both in scope and content, and will be released on a newly designed website in three interweaving parts:

• Part A: Common clinical conditions in aged care (available online now)
• Part B: General approaches to aged care (early-to-mid 2020)
• Part C: Organisational approaches to aged care (mid-to-late 2020)

All GPs who work with older patients will recognise the increased prevalence of falls, dementia, mental health conditions, chronic pain, incontinence, among other clinical conditions. These are often compounded by the existence of multimorbidity and polypharmacy, which in my own practice are prevalent in most if not all older patients.
 
With that in mind, Part A of the Silver Book is intended to be used as a point-of-care reference, and designed to assist in clinical decision-making by presenting a snapshot view of the diagnosis and management of a range of common clinical conditions in aged care.
 
For experienced GPs who often face the many barriers of providing clinical care to older patients, including time management, the ‘General principles’ section provides a quick snapshot of the common clinical condition for reference and review.
 
For general practice registrars and GPs who are new to aged care work, additional information and external resources are listed below the ‘General principles’ section, which provides in-depth knowledge about the common clinical condition.
 
During the EAG’s review of the literature, it became evident that robust grades of recommendations and levels of evidence in this broad field of medical care is scarce. Specific clinical recommendations thus cannot be provided, as the inclusion and exclusion criteria are often too restrictive and unhelpful.
 
The clinical recommendations are often single-disease specific and fail to consider comorbidities, patient needs and polypharmacy that most (if not all) older people experience. The Part A chapters on multimorbidity, palliative and end-of-life care, and polypharmacy should therefore be read in parallel with all other chapters.
 
As with all other areas of general practice, every clinical decision made regarding the condition of older people must be considered using a person-centred approach. Clinical decisions must recognise that the diagnosis and management for each patient will differ depending on the patient’s medical, family, social and environmental history and circumstances. An appropriate and effective management plan can only be established once the above considerations have been discussed with the patient and their carers.
 
On behalf of the EAG, I hope you find this new edition of the Silver Book to be resourceful in your day-to-day practice.
 
The EAG will be presenting a workshop on the challenging clinical conditions in aged care at the GP19 conference.

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aged care International Day of Older Persons Silver Book

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