What is 'Acopia'?
The word 'acopia' is often used to describe a patient’s inability to cope with activities of daily living. The term 'acopia' is not found in the English dictionary, yet it is often seen within the initial triage notes from Emergency Departments. This diagnosis follows patients throughout their hospital admission. The term has been shown to be linked with an older population and is used to describe either patients with no acute medical problems or for individuals who are categorised as inappropriate admissions. David Oliver (a former government adviser on the elderly) has argued that the term is not a diagnosis and that the inappropriate terminology is unhelpful towards ensuring quality patient care. David Oliver argued that the term is subconsciously prejudicial against age and subconsciously allows doctors to brand geriatric patients with the inability to cope, when in reality this patient population are most likely suffering from multiple co-morbidities and geriatric syndromes, such as acute confusion, dementia, falls and incontinence. As therapists we must work alongside our medical colleagues to provide holistic care, ensuring patients receive appropriate and effective treatment, identifying the problems that can be reversed and rehabilitating individuals to maintain their independence and quality of life. The term 'acopia' may bias clinicians thought processes and cause diagnoses to be missed and reversible pathology to be underdiagnosed.
A study carried out within an NHS District General Hospital found that nearly half of patients described as having ‘acopia’ presented with geriatric syndromes, such as falls, immobility and confusion. The authors argued that the definition of acopia should be an inclusive term to describe the frail elderly patient with multiple medical problems, enabling health professionals to identify when specialist intervention is needed within the multi-disciplinary team. This particular study also found a number of interesting facts:
•The term 'acopia' is most commonly used in elderly patients. The majority of these patients had acute medical illnesses or co-morbidities.
•Over half of the patients described as having 'acopia' did not previously receive social service input.
•The results suggested that an inability to cope at home is an indicator for medical illness. These patients also had a mortality rate higher than average, suggesting that urgent medical treatment is required within this population.
Elements of a Comprehensive Geriatric Assessment
The benefits of carrying out a comprehensive assessment for this population include lower mortality rates, increased physical function, greater ability to remain at home, reduced readmission's to hospital and overall improved quality of life.
| Medical Assessment
|| Problem List|
|| Co-morbid Conditions and disease severity|
|| Medication review|
|| Nutritional Status|
| Assessment of Functioning
|| Basic Activities of Daily Living|
|| Instrumental Activities of Daily Living|
|| Activity / Exercise Status|
|| Gait & Balance|
| Psychological Assessment
|| Mental Status (Cognitive Testing)|
|| Mood / Depression Testing|
| Social Assessment
|| Informal Support Needs and Assets|
| Environmental Assessment
|| Care resource eligibility / financial assessment|
|| Home Safety|
|| Transportation and Telehealth|
The table above shows the key stages to completing a comprehensive assessment by a multi-disciplinary team within acute health care. Assessment of functioning is not the only element that a physiotherapist needs to consider when treating patients holistically. A therapist needs to consider all of the above elements to provide effective care, referring to or getting advice from other colleagues as needed.
- Keel YK, Rippingale C. The prevalence and characteristic of patients with ‘acopia'. Age Ageing 2009; 38(1): 103-105.
- Richardson DB. Elderly patients in the emergency department: a prospective study of characteristics and outcome. Medical Journal of Australia 1992; 157:234-9.
- Oliver D. ‘Acopia’ and ‘social admission’ are not diagnoses: why older people deserve better. Journal of the Royal Society of Medicine 2008; 101(4): 168–174.
- Obeid J, Ogle S. Acopia: a useful term or not? Australasian Journal of Aging 2000;19:195-8.
- Association for elderly education. Acopia- the diagnosis for doctors who can't cope. Available from: https://www.youtube.com/watch?v=f53F-dAg_5Q (last accessed 5.5.2019)
- British Geriatrics Society. Comprehensive Geriatric Assessment for Frail Older People in Hospital. London: BGS; 2005.