Page 88 - HA Convention 2015

Special Topics

ST2.1 Nursing — Rehabilitation and Elderly Services 13:15 Theatre 1

Monday, 18 May A Paradigm Shift for the Care of Elderly Patients
Ho JKY
Department of Integrated Medical Services, Ruttonjee and Tang Shiu Kin Hospitals, Hong Kong

HOSPITAL AUTHORITY CONVENTION 2015 Background

As older persons represent a dominant age group among people receiving health services, a new approach to hospital care
is imperative — “elder-friendly care” which takes into account the special considerations of older persons in a setting that
focuses on acute illnesses.

The Department of Geriatrics of Ruttonjee and Tang Shiu Kin Hospitals took the initiative to implement elder-friendly care
in the acute hospital setting. We plan to put the concept into practice with the context of leadership, physical environment,
process of care, emotional and behavioural climate.

Leadership

Moving towards an elder-friendly care requires a cultural shift. An Advisory Committee was established to advise the needs
of older patients, create a culture that empowers friendly senior care and with high interest in developing staff geriatric
competencies.

Physical Environment

A gerontologically sensitive hospital design compensates older persons’ declining capacities. With the opportunity of setting
up a new acute medical ward in the hospital, we made some affordable elder-friendly physical designs in the ward. It takes
account of colour, lighting, navigation in ward and interior designs to optimise performance, reduce risk of injury and protect
functional abilities in older patients.

Process of Care

Elder-friendly care should base on evidence-based processes which acknowledge the physiology, pathology and social
science of frailty and ageing. The department adopts the standards from the Hospital Authority Acute Care for Elderly (ACE)
Project which assists frontline to use structured prevention and management interdisciplinary protocols with accredited
screening tools to identify level of risk and establish mutually agreeable referral mechanisms. Key performance indicators
were also identified for close monitoring and on-going evaluation of care outcomes.

Emotional and Behavioural Climate

A friendly atmosphere means our staff interacts with older patients in a respectful, supportive and caring way.

Satisfaction survey and focus group interview were conducted to understand the comment of patients and their relatives
towards our care. With the aim to improve staff knowledge and skills on gerontological care, the department has revised the
induction programme, staff training and development plan to focus more on gerontological nursing care.

Patient navigation process was further reviewed to strengthen orientation. Adequate education materials were provided to
empower older persons and their relatives for self-care.

Conclusion

Creating an elder-friendly care in an acute hospital requires a multi-dimensional and synergistic approach. But more
importantly, it requires a paradigm shift in thinking. The elder-friendly care was implemented in the context of leadership,
physical environment, processes of care, emotional and behavioural climate. They work together to promote safety, minimise
functional decline, alleviate adverse social and medical outcomes for older adults.

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