How to undertake a structured telephone consultation with an older person experiencing breathlessness

Breathlessness is one of the most common and clinically significant symptoms encountered in older people. It may indicate an acute infection, heart failure, chronic respiratory disease exacerbation, pulmonary embolism or other serious pathology. Telephone consultations enable nurses to assess the patient rapidly and direct them to appropriate care. However, the absence of direct observation, physical examination and independent measurement of physiological parameters means that a structured and systematic approach to the telephone assessment of breathlessness is required. • Telephone consultations can make it more challenging to assess symptom severity and identify clinical deterioration in older people. • Older people with a new or worsening respiratory condition may present with less obvious breathlessness and more non-specific features such as fatigue, confusion or reduced ability to carry out their daily activities. These atypical presentations can make clinical deterioration more difficult to recognise. • Using a structured approach can support clinical decision-making and help nurses recognise when escalation to emergency services or same-day face-to-face review by a GP is required. REFLECTIVE ACTIVITY: 'How to' articles can help update your practice. Apply this article to your practice and reflect on: • How this structured approach will change the way you undertake telephone consultations with older people experiencing breathlessness. • How you could use this information to support the learning of nursing students or colleagues.