Hospitalized elders often have multiple and complex medical issues, requiring comprehensive assessment and close attention by a well coordinated treatment team. Furthermore, hospitalization for the frail elderly can pose a significant risk for a decline in general function. The Acute Care for the Elderly (ACE) Unit at Maine Medical Center is specifically designed to address these needs and to prevent functional decline in acutely ill, hospitalized, community dwelling elders and assist them and their families with the transition back into the community. This multidisciplinary model of care has been shown nationally to significantly improve the clinical outcomes of hospitalized elderly patients, improve their functional status at discharge and reduce the rates of transfer to nursing homes.
The program's success lies in its attention to maintaining physical and psychosocial functioning despite an acute illness and in its provision of education and support to patients and their families around medications, geriatric syndromes, living options and community resources. The philosophy is further complimented by an environmental design and that encourages mobility and prevents physical injury. There is a focus on getting patients out of bed and moving around as early in the hospital stay as well as attention to delirium prevention.
Patients over the age of 70 on the ACE Unit at Maine Medical Center are evaluated for risk factors that can result in functional decline. These risk factors include: evidence of geriatric syndromes, such as hearing or vision impairment; impaired mobility; altered urinary or bowel elimination; cognitive dysfunction as evidenced by presence of depression, delirium and/or dementia; dehydration/malnutrition; impairment of self care; living alone or with poor social supports; hospitalization within last 31 days; or evidence of neglect or abuse. The specifics of the individual cases are reviewed in a daily interdisciplinary team meeting.
The ACE Unit team at Maine Medical Center includes a
- Advance Practice Geriatric Clinical Nurse Specialist
- Physical or Occupational Therapist
- Social Worker
- Chaplain representative
- Care Coordinator
- Nurse Manager
- Nurse Director
- Charge Nurse
- Geriatric Psychiatric Nurse Practitioner
This team meets daily to review risk factors for decline and make recommendations to minimize or modify these factors. The team begins discharge planning from admission, attempting to identify a reasonable discharge date and location that takes into consideration the medical and social considerations of the individual patient. Individual team members will meet with patients related to specific issue raised by the team or expressed by the patient or their family. In addition, nursing care protocols are initiated to target risk factors.
Common diagnosis in patients on the ACE units are likely to be congestive heart failure, dehydration, mental status change, gastrointestinal bleeding, pneumonia, stroke, or chronic obstructive pulmonary disease.
A hospital stay can be overwhelming for anybody, but it can be particularly bewildering for the elderly. Hospitalized older adults suffer a significant disruption in their daily routines and can become easily confused and disoriented. The medical term for this is delirium and more than 2 million older Americans each year develop this sudden change in mental status during a hospitalization. The Hospital Elder Life Program (HELP) is an innovative approach to improving hospital care for older patients, helping to make the most of their hospitalization and decrease the likelihood of delirium. HELP is designed to prevent delirium before symptoms develop and studies have shown that encouraging simple activities such as frequent orientation and reminiscing, patients are less likely to develop delirium and go on to suffer the consequences that it can bring. If not prevented or detected early, delirium may last six months or more, leading to functional decline, a longer hospital stay, and the potential need for long term care.
The primary goals of HELP are to:
- Maintain cognitive and physical functioning of high risk older adults throughout hospitalization
- Maximize independence at discharge
- Assist with the transition from hospital to home
- Prevent unplanned hospital re-admissions
HELP uses specially trained volunteers to maintain physical and cognitive functioning and decrease confusion for older patients who are at high risk. This program is available to seniors throughout the hospital and some of the services provided include:
- Daily Visits
- Feeding Assistance
- Therapeutic Activities
- Early exercise
- Sleep enhancement without medications
- Vision/Hearing devices
- Provider Education Programs
- Linkages to Community Services
What is delirium?
Delirium is defined as a sudden change in mental status, or onset of confusion that develops over hours or days. It can cause problems with thinking, difficulty paying attention, hallucinations and paranoia and it can also cause changes in personality. Delirium is a serious problem for a hospitalized older adult as it can slow the recovery process and lengthen the hospital stay. What can be done to help prevent delirium?
- A friend or family member with you to the hospital. Ideally someone to stay with you during initial evaluation and admission. This person can help keep track of what is happening and provide/verify information about usual level of functioning if needed.
- Glasses to help navigate a new environment
- Hearing aids to help with communication
- Dentures to promote eating/nutrition
Have a list that includes:
- Prescription medications (including eye drops and medications used on an as needed basis)
- Non-prescription medications (including herbals, vitamins and medication used only when needed)
- Physicians (include phone numbers)
- Family/Friends with contact numbers (include home, cell, and work numbers)
In the Hospital:
- Ask hospital staff to post the date, name of the hospital, and the room number in the room where it is easily visible. Family/friends can gently remind their loved one of the date/season and where they are when they visit.
- Make sure call bell, phone, TV remote and any other necessities are easily within reach.
- Walk at least 3 times each day. You may need assistance due to weakness or tubes, so discuss with your nurse the need to use a call bell for assistance.
- Stay awake in the daytime to promote sleep at night. Bring in activities such as books, crosswords, or magazines to help pass the time. Pictures are also fun to look at, talk about and help staff know you better.
- To promote sleep, go to bed at your usual time. Turn off the TV. If you have trouble falling asleep, try some herbal tea, back/hand massage, and/or quiet music to help relax. If you are being awakened for medications or vital signs, ask your doctor if this is necessary or if times can be changed to promote sleep.