Older people have a higher risk of functional decline and preventable harm during a hospital stay than younger people. This is due to changing physiology and the presence of multiple, complex and often chronic problems.
Clinicians often focus on an older person’s acute health problems that led to the hospital admission. We may neglect to prioritise issues such as nutrition and hydration, maintaining mobility, providing good pressure care and the psychosocial and emotional needs of the person - all of which can impact negatively on an older person’s outcomes.
The issues of social isolation and loneliness, which are distinct but related concepts, are gaining increasing attention in Australia and overseas as they can have a significant impact on an individual’s health. Identifying those at risk of these issues and developing a person-centred plan to actively engage the older person, encouraging them to participate in their care in hospital and after their discharge, is integral to good care.
Providing the best care for older people rarely requires a single intervention. However, the complexity of integrating multiple assessments, managing best practice interventions for different risks and integrating patient preferences is not a straightforward task.
Screening and assessment on admission and throughout an older person’s hospital stay can help us to quickly identify and respond to actual or potential risks to patient safety and wellbeing.
This topic provides an overview of some components of screening and assessment. It is to be read in conjunction with the accompanying clinical topics and with health service policy and procedures.
All Australian hospitals are being accredited under The Australian Commission on Safety and Quality in Healthcare’s (ACSQHC) National Safety and Quality Health Service (NSQHS) Standards. Each of the ten standards relate to optimising clinical care and better outcomes for all patients. This topic highlights the need to approach the clinical issues older people face in hospital in a holistic and person-centred way in order to identify and respond to multiple modifiable risk factors throughout their stay. Doing this will improve our systems, clinical care and ultimately the outcomes for older people to prevent falls and harm from falls (standard 10), prevent and manage pressure injuries (standard 8) and improve medication safety (standard 4) and identify and respond to clinical deterioration (standard 9).