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How How can the hospitals can the hospitals

become a good place for become a good place for older patients?older patients?

Virpi Honkala

Raahe Health Area

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Ratio of over-60sto the population

aged 20-59 inthe enlarged EU

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:– 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 goodplenty of friends and hobbies (95 %) continuous long history of work strong people despite of hardships in

lifehappy 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:

– 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 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

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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

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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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GOOD AGEING

body condition

values and philosophy of life

social conditions

opennessimagination

activities for the brain