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Enhancing Elderly Care in Hospitals: A Comprehensive Approach

Learn how hospitals in Finland improve care for older patients, preventive measures, challenges, and key factors for successful aging. Discover the importance of patient-staff communication, mobility, and medication management.

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Enhancing Elderly Care in Hospitals: A Comprehensive Approach

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  1. How can the hospitals become a good place for older patients? Virpi Honkala Raahe Health Area

  2. RAAHE HEALTH AREA, FINLAND

  3. Senior preventive study • all those born in 1939 were invited (357) • the official age of retirement • often time for dramatic changes in life • 88 % participated • few had frequent visits due to chronic diseases • few had no previous visits to public health care • alcoholism or nonsocial lifestyle • 6 died during the year

  4. Senior preventive study • Tool kit of a qualified nurse: • laptop • scale and measuring tape • blood pressure meter • E-chart and reading chart • PEF-meter • tests of memory and mood • educative leaflets • the most popular: sleep of the elderly • Laboratory examinations: blood count, fluid balance, lipids, B12, folate, Ca, fb-gluc, TSH

  5. Senior preventive study • Measurements and questions asked: • measuring of height, weight, hearing, sight • general health: medication, chronic diseases • physical condition: PEF, cycling ability • sleeping habits • social life: friends, hobbies • living conditions: doors, steps, sanitary accommodation • memory and mood • work history • security and future planning

  6. Senior preventive study • physical condition was fairly good • plenty of friends and hobbies (95 %) • continuous long history of work • strong people despite of hardships in life • happy with life • enthusiastic about changes

  7. Senior preventive study • blood pressure: 39 % > 130/85 • medication 48 % • BMI: 9 % < 22, 28 % >30! • fb-gluc: 46 % > 5.5 mmol/l • cholesterol: 66 % > 5 mmol/l • only 39 % had normal bone density! • 14 % smokers, 6 % former heavy drinkers • 13 % had minimal memory problems

  8. If nothing is done: this becomes true also for them! Causes that ”ruin” good ageing • musculoskeletal disorders • eg. osteoporosis, fractures • diabetes • complications: cardiovascular, cerebral, neurological • dementia • loneliness • hearing and vision impairment

  9. Senior in hospital • PROBLEMS: • over/ underdiagnostics • ”overcare” – minor findings become main causes for treatment • diagnostic ”labeling”: e.g. dementia, cancer • diminishing of independence • polypharmacy and complications of medication • immobilisation • changes of places of care (rooms, wards, hospitals)

  10. Senior in hospitalunsuccessful care – why? • DUE TO STAFF: • the former condition or situation of the patient is unknown • the advice or information given is incomplete • lack of geriatric knowledge and/ or skills • pessimistic attitude • limited resources, hurry • administrative difficulties

  11. Senior in hospitalunsuccessful care – why? • DUE TO PATIENT: • vagueness of symptoms • inability to describe the illness • no cure for the illness • several simultaneous diseases • quick deterioration if the treatment is delayed • unsuitable or wrongly dosed medication • misunderstood information • extended recovery phase • negligent lifestyle • unsuitable living conditions, loneliness

  12. Good care – important to remember: • discharge of a senior patient from the hospital care begins from the moment of signing in • living conditions, home care, mobilisation • relatives / friends / social workers / nurses • mobilisation • VIP – patients: notified in the patient chart • nutrition • difficulties in diagnosis • confusion is a symptom for many diseases

  13. Dangers of immobilisation • a week in bed diminishes 25 % of muscular strength • skin problems, joint stiffness, osteoporosis • circulatory thrombosis • head seems to get attached to the pillow soon and getting up feels uncomfortable • ortostatic hypotension, pulmonary problems • lack of appetite, constipation, urinary infections, bladder dysfunction • changes in medicine metabolism, more side effects • if one does not move enough, one’s imagination flies • depression, worsening of dementia, possible delirium

  14. Medication • Dr. Karjula: ”When I was a young doctor, my concern was how to prescribe the right medication. Now my concern is: which one of the medications has caused these symptoms.” • Also, freely available medicines and natural medicine-like products must be taken into consideration

  15. values and philosophy of life GOOD AGEING body condition social conditions activities for the brain openness imagination

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