What is it?
Best care for older people in hospital uses a person-centred approach and evidence-based tools and resources to identify and respond to the risks associated with hospital admission.
To provide best care we must consider how the person’s medical treatment and healthcare may limit their activity as well as impact on their level of independence and ability to return to their pre-morbid lifestyle. During their stay in hospital older people can:
- experience falls
- develop a delirium
- become malnourished or dehydrated
- develop depression
- become incontinent
- experience unidentified or poorly managed pain
- develop pressure injuries.
Any of these issues can have a significant effect on a patient’s ability to maintain a level of independence that allows them to return home.
Why is it important?
- As the population ages, older people are becoming the major user of hospital services.
- Older people who present to hospital have a significantly higher risk of experiencing functional decline.
- Older people have diverse care needs. These challenge the traditional care models of modern hospitals that focus on single disease or conditions at the expense of a holistic person-centred approach.
Frailty is estimated to effect a quarter to a half of all older people. Being frail means that relatively minor stressors can trigger significant changes in health status.1
Dementia is highly prevalent in older people and becomes more prevalent with increasing age. It is estimated that between 21 and 24 per cent of those aged 85 years and over have dementia.2
- Having dementia puts patients at significantly higher risk of adverse outcomes such as falls and delirium.
How can you provide the best care for older people in hospital?
Find out what matters to your patient. It is essential to be person centred in every encounter you have with older people, their families and carers.
This approach is the cornerstone of providing the best care for older people in hospital. Consider your patient’s treatment needs in the context of their physical and mental health, their emotional and social needs.
The following evidence-based strategies will play a large role in improving your patient’s experience and outcomes in hospital:
Treat the person not the disease. With many older people having multiple medical conditions you need to identify what is important to the person.
Monitor the older person for signs and symptoms of clinical deterioration. Routine vital signs on their own will not alert clinicians to changes in an older person’s health status.
Promote independence through encouraging your patient to be dressed, to self-care, mobilise and toilet themselves. Prolonged resting in bed must be avoided.
Ensure your patient is eating and drinking. A high percentage of older people present to hospital malnourished.
Look out for changes in cognitive and functional status, which may indicate that your patient is developing a delirium.
- Always involve family and carers in all aspects of care planning. Family and carers know the person best and can provide an understanding of pre-morbid level of function.
- Screen the older person’s family or carer for psychosocial and emotional wellbeing issues and link them with appropriate supports during their stay.
- Identify, respond and develop a plan to manage an older person’s pain. Pain is highly prevalent in older people; it is commonly under-treated and can affect an older person’s efforts to self-care.
- Review medications. Older people are more at risk of experiencing problems related to medications.
- Recommend frail older people for a comprehensive geriatric assessment. This should not be delayed because of other medical issues.
1. Clegg A, Young J, Iliffe S, Rikkert MO & Rockwood K 2013, ‘Frailty in elderly people’, Lancet, 381(9868):752-62.
2. Deloitte Access Economics 2011, Dementia Across Australia, 2011–2050, Report to Alzheimer’s Australia, Kingston.