Improving Care For Older People (Ic4Op)
As clinicians working in a hospital we can make a difference. What we do, or don't do, will affect an older person's likelihood of functional decline. A key thing we can do is to be person-centred in our practice. Put simply, this means treating older people with respect and as equal partners in the health care relationship. We need to listen to the older person, take time to get to know them and engage with them as an equal.
Tips on reducing patients' risk of functional decline are outlined in ‘Best care for older people everywhere - The toolkit’. The toolkit uses symbols to identify each domain. Pain has just been completed and palliative care and communication are currently under development.
There are some very practical things we can do. For example, ensure that every patient is oriented to the ward environment so they:
- know how to get to the bathroom.
- have a call bell within reach.
- know where the nurses' station is.
- know where to go for meals, if dining in a dining room.
Patients may need to be reminded on more than one occasion.
Encourage incidental activity and independence
It is very important that older people are kept as mobile and independent as possible whilst in hospital as this will help to reduce falls, improve appetite, reduce muscle deterioration and reduce the risk of pressure ulcers.
It is important to encourage older people to do as much as possible for themselves. Personal activities of daily living that can be maintained in hospital include showering, dressing, shaving and applying make-up. These activities not only promote independence but help patients to maintain their dignity and encourage them to participate in other activities.
Adequate hydration is very important in reducing the risk of infections, delirium and incontinence. Ensure fluids are:
- Palatable to the patient.
- Replenished regularly.
- Within reach, and the patient can refill their glass or get help to do so.
Ensure adequate nutrition
Adequate nutrition is important to reduce the risk of functional decline. Ensure:
- Food is palatable to patients.
- Patients have adequate set up and access to their food.
- Patients have enough time to eat.
- Distractions at mealtime are reduced.
Monitor skin integrity and take steps to prevent pressure areas and skin tears, such as:
- Avoid using soap.
- Encourage patient to remain as mobile as possible (see above under activity and self-care).
These are just some of the actions you can take. For more information see the toolkit.
Health professionals should also consider referral to HARP if the patient has multiple health conditions and is at risk of readmission. Referral to social work, occupational therapy, physiotherapy, speech pathology, discharge planning, continence, wound care, infection control, the aged care placement coordinator or other relevant services should be considered as indicated by the initial assessment.