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 public and private hospitals are required to be accredited to the Australian Commission on Safety and Quality in Healthcare’s (ACSQHC) National Safety and Quality Health Service (NSQHS) Standards. The primary aims of the standards are to protect the public from harm and to improve the quality of health service provision. Assessment to the second edition of the NSQHS Standards commenced in January 2019. The second edition comprises eight standards that provide a nationally consistent statement about the level of care consumers can expect from health services.
The Comprehensive Care Standard (Standard 5) aims to ensure that patients receive comprehensive health care that meets their individual needs, and considers the impact of their health issues on their life and wellbeing. It also aims to ensure that risks of harm for patients during health care are prevented and managed through targeted strategies. These include integrating patient care processes to identify patient needs and identifying actions related to falls, pressure injuries, nutrition, mental health, cognitive impairment and end-of-life care.
Information is presented in the Older People in Hospital learning topics that complements Standard 5 and other NSQHS Standards including the; Partnering with Consumers Standard (Standard 2), Medication Safety Standard (Standard 4), Communicating for Safety Standard (Standard 6) and Recognising and Responding to Acute Deterioration (Standard 8).