Monday, 2 May 2016

Hospitals and frail elderly patients

Health Service Journal published a report from a committee of experts based on several previous publications, including the British Geriatric Society, Future Hospital Report and King's Fund. From the conclusions of the report I want to highlight some ideas that in my opinion are important:

a) Age should never be a barrier to receiving appropriate, coordinated, safe, efficient and effective care.

b) Integration of social and health services within the community framework is the best approach that can be offered to the group of frail elderly people, although this does not prevent the occurrence of circumstances that may require hospitalization.

c) The emergency departments of hospitals should have the geriatric culture well established in order to make appropriate choices and avoid unnecessary admissions.

d) If the frail person qualifies for hospitalization, the practice of geriatric assessment is imperative as is the practice of developing an individualized treatment plan, because it has been shown that if this methodology is followed through, patients are 30% more likely to survive and go home.

e) Hospitals should not expose patients to risks caused by gaps in communication, changing beds (especially after hours), changes concerning specialists, etc. Geriatric multidisciplinary teamwork, the individualized treatment plan and well-planned home transfers constitute the only supply of safe hospital care for this group of patients.

f) Geriatric patients need time to be spent with them and want to be heard and this sometimes goes against the rush and working models of hospital wards. Lack of communication is bad in general, but in the case of these patients, in particular, is a source of errors and complications.

g) During hospitalizations, guidelines for the prevention of major hospital specific iatrogenic problems should be put in practice, and most of them involve nursing work: bedsores, disorientation (and delirium), infections, falls, thromboembolism, malnutrition, dehydration, etc. We must not forget that a prolonged hospital stay may increase, by itself, the frailty of the patient.

The Commission has produced a video called "What has gone wrong in Mrs Andrews’ care process?" An illustration explains the case of Mrs June Andrews, a frail lady of 84 years who, one Friday afternoon, fell in her bathroom at home and an ambulance takes her to the emergency room and she is admitted to hospital. Meanwhile, Dr. David Oliver, a geriatrician from the Commission comments on the erroneous or improvable actions in the process of caring for Mrs Andrews within the hospital.

This is not a new document, but instead provides us with an overview of the known evidence, while encouraging hospitals to provide quality care to frail elderly patients, which means that many of these should mobilize to incorporate geriatric methodologies and teamwork at all levels of the organization.

Jordi Varela


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