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How can the hospitals become a good place for older patients?

How can the hospitals become a good place for older patients?. Virpi Honkala Raahe Health Area. RAAHE HEALTH AREA, FINLAND. 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

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How can the hospitals become a good place for older patients?

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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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