Providing Best Care for Older People in a Hospital Setting
Published: 07 August 2023
Published: 07 August 2023
Hospitalisation is an overwhelming event for older people that places them at significant risk of complications and deterioration at the best of times (QUT 2017).
Older adults face a unique set of risks and challenges in hospital settings. Therefore, knowing how to care for these vulnerable people is crucial (QUT 2017).
Older adults may feel highly distressed coming into an acute care setting. In addition to the pain or illness they are experiencing, they may also be concerned about the implications of being hospitalised and how it will affect their independence, routine and sense of self (Commission on Dignity in Care 2012).
Older patients may be frightened, confused, frustrated or angry. It’s important to empathise with these emotions and care for them in a way that is sensitive to their distress (Commission on Dignity in Care 2012).
Older adults are also at high risk of developing complications during a hospital stay. These include:
(Health.vic 2015; RACGP 2019)
They may face other challenges that impede their lifestyle, including:
(QUT 2017)
When caring for an older adult in hospital, the aim is for them to return home at the level of functioning they had before admission or better (QUT 2017).
Transitions between aged care and acute care, or any other settings, are high-risk and can result in miscommunication or other adverse consequences such as:
(ACSQHC 2017; RACGP 2019)
All patients have the right to dignity and autonomy, regardless of age. However, in acute care settings, this may be a low priority for staff (Tauber-Gilmore et al. 2017).
Generally, older adults are at a high risk of losing dignity when in care (Šaňáková & Čáp 2018).
Dignity and autonomy play a significant role in a patient’s overall condition. Positive, respectful interactions will increase the patient’s confidence, motivating them to maintain independence and stay physically and mentally active. On the other hand, neglectful, condescending or apathetic care will quickly correlate to deterioration and functional decline (Commission on Dignity in Care 2012).
A literature review identified the following key components of dignity, based on the views of older adults:
(Šaňáková & Čáp 2018)
Empowering older adults, providing them with choice and treating them with dignity is essential in reaching desirable patient outcomes. Older adults want to be treated as people, not nuisances (Commission on Dignity in Care 2012).
Care that promotes dignity | Care that reduces dignity |
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(Commission on Dignity in Care 2012)
Over 30% of older adults present with or experience confusion during hospitalisation, usually due to dementia or delirium (ACI 2015).
These patients may be particularly overwhelmed. In addition to pain, illness or emotional distress, they may also:
(ACI 2015; Yous et al. 2019)
The risk of complications is even higher among older patients with cognitive impairments (Bail & Grealish, cited in Cook et al. 2020).
Read: Dementia Awareness and Delirium Awareness and Cognitive Impairment
Research suggests that only 14% of hospitals have physical environments that are appropriate for patients with a cognitive impairment (Alzheimer's Australia 2014).
Acute care facilities are busy and fast-paced environments, with noises, lights, signage and room layouts that can be highly confusing for older adults and significantly contribute to distress and disorientation, especially for patients with a cognitive impairment (Alzheimer's Australia 2014).
Patients need to feel safe, secure and oriented, which can be very difficult if the toilet is hard to find, or the patient does not know how to get back to their room (Alzheimer's Australia 2014).
When caring for older adults in acute settings, consider the following:
(QUT 2017; Health.vic 2015)
Older adults with a cognitive impairment require extra support and orientation. In addition to the practical tips above, you should:
(ACI 2015; Alzheimer's Australia 2014; ACSQHC 2014)
Older adults who become hospitalised may be highly distressed and are vulnerable to complications, especially if they have a cognitive impairment. Caring for these patients appropriately is essential in achieving positive outcomes and preventing deterioration or functional decline.
Question 1 of 3
Approximately what percentage of hospitals have physical environments that are appropriate for patients with a cognitive impairment?