Transcript How can the hospital become a good place for - HPH

How
can the hospitals become
a good place for older
patients?
Virpi Honkala
Raahe Health Area
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Ratio of over-60s
to the population
aged 20-59 in
the enlarged EU
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RAAHE HEALTH AREA, FINLAND
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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
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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
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Senior preventive study
 Measurements and questions asked:
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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
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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
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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
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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
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Senior in hospital
 PROBLEMS:
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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)
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Senior in hospital
unsuccessful care – why?
 DUE TO STAFF:
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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
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Senior in hospital
unsuccessful care – why?
 DUE TO PATIENT:
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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
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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
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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
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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
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body condition
values and
philosophy of life
social conditions
activities
for the brain
imagination
GOOD AGEING
openness
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