Like all hospitals in Ontario, St. Michael’s Hospital is looking at how best to address the unique needs of seniors.
Susan Blacker, director in charge of developing the elder care strategy at St. Michael’s, says, “There are a number of areas where a focused and systematic approach can provide clear benefits to the elderly. Two examples of initiatives now in implementation are: early mobilization and the prevention, diagnosis and treatment of delirium.”
Early mobilization key
Dr. Sharon Straus, a geriatrician and director of the Knowledge Translation program at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, says, “Research shows that without mobilization, an elderly patient will lose one to five per cent of his or her muscle strength every day in hospital. About one-third of adults lose at least one activity of daily living when in hospital – many never recover fully.”
St. Michael’s, along with 14 other teaching hospitals in Ontario, is studying the impact of getting people moving very early in their hospital stays. The goal, according to Dr. Straus, is to assess all seniors within 24 hours of their arrival in hospital, develop care pathways that ensure mobility and then, make sure seniors are up and around at least three times a day.
Early mobilization can be significant – reducing length of stay, improving a return to pre-hospital functional status, less depression, increasing discharge home rather than to alternate levels of care and lowering hospital costs.
In another initiative, St. Michael’s has been looking at the impact of delirium on the elderly while in hospital. Delirium is a sudden onset of fluctuating awareness, impairment of memory and attention and disorganized thinking.
People with delirium may also have hallucinations and sleep-wake disturbances.
Terri Irwin, professional practice leader for nursing, says, “The research is frightening: 15 per cent of the elderly who come into hospital will have delirium, another 14 to 56 per cent will develop delirium during their hospital stays, and as many as 70 per cent of those cases will not be detected.”
To combat delirium, St. Michael’s nurses are using a method to assess confusion in order to screen for delirium. A team led by project manager Orla Smith developed “HANDOVER” prevention strategies: hydration, activity and mobilization, nutrition, drugs, orientation, vision and hearing, elimination and rest/sleep.
When someone is diagnosed with delirium, there is now a pre-printed order set to ensure consistent and appropriate treatment. Families are invited to participate in developing care plans to help identify potential problems and to play a role in personalized solutions.