Elder Care In Hospital

  A Review of Constant Care

Melvin Layden, Eastern Health, NL.

The Project

In 2012, British Columbia proposed a model of care for hospitalized seniors (aged 70 and up) using the Hospital Care for Seniors: 48/6 Approach. Six domains of care formed the focus of the model, emphasizing improved screening and assessment. This emphasis highlighted key issues, pointing to the need for individual care plans to address them.

The six domains in the model are: Bowel & Bladder Management, Cognitive Functioning, Functional Mobility, Medication Management, Nutrition & Hydration, and Pain Management. The 48/6 Approach recommends that within 48 hours of hospital admission all seniors be screened for needs based on these six domains, and have an appropriate care plan initiated. Recently, a seventh domain, Psychosocial, was added.

An interdisciplinary committee comprising Occupational Therapy, Nursing, Physiotherapy, Social Work, Medicine, Pharmacy and Library Services collaborates on developing supports around the domains using their own current clinical experience and research evidence. The committee meets monthly.

Hazards of Hospitalization

Each day, more than 55% of acute care hospital beds in Canada are occupied by older patients.
Canadian Institute for Health Information, 2013

About 85% of non-nursing home older adults in the United States are not considered to be frail (Bandeen-Roche et al., 2015). However, acute illness can quickly have an impact on older adults, especially those with pre-existing diagnoses (e.g. dementia or chronic lung disease), propelling them into a downward spiral that may require hospitalization. The individual older adult now presenting as frail, may have been active in their community, living independently and managing instrumental activities of daily living one week earlier.

If the majority of older adults are not frail before they enter the hospital, why do 30% of older adult inpatients experience significant functional decline after being admitted to hospital (Covinsky et al., 2003)? This functional decline may present as deconditioning, decreased muscle strength, increased dependence, dehydration, incontinence, delirium, increased length of stay, increased risk of skin breakdown, and falls. Many older adults end up being discharged in worse shape than before their acute illness (Landefeld, 2003). Hospital care can make older adults more frail.

This subject guide highlights key domains of care to support health care providers with changing inpatient older adult outcomes for the better.

Bandeen-Roche, K., Seplaki, C. L., Huang, J., Buta, B., Kalyani, R. R., Varadhan, R., Xue, Q., Walston, J. & Kasper, J. D. (2015). Frailty in older adults: a nationally representative profile in the United States. The Journals of Gerontology: Medical Sciences Series A, 70(11), 1427-1434.

Canadian Institute for Health Information. Inpatient hospitalizations: volumes and length of stay. Ottawa, ON. 2012-2013.

Covinsky, K. E., Palmer, R. M., Fortinsky, R. H., Counsell, S. R., Stewart, A. L., Kresevic, D., Burant, C. J. & Landefeld, C. S. (2003). Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. Journal of the American Geriatrics Society, 51(4), 451-8.

Creditor, M. C. (1993). Hazards of hospitalization of the elderly. Annals of Internal Medicine, 118(3), 219-223.

Gillis, A., & MacDonald, B. (2005). Deconditioning in the hospitalized elderly. The Canadian Nurse, 101(6), 16-20.

Landefeld, C. S. (2003). Improving health care for older persons. Annals of Internal Medicine, 139(5 Part 2), 421-424.