Changing the way care is provided in hospital for older adults with frailty is essential to ensuring equitable access to care and improving patient flow, which have been particularly important throughout the COVID-19 pandemic (Regional Geriatric Program of Toronto, 2020). Optimizing patient flow will be essential for hospitals as they work to address backlogs in elective surgeries and medical admissions for older adults with conditions that were exacerbated during the pandemic, while also responding to the second wave. Enhancing care for older adults will be key strategy for reducing lengths of stay (LOS) and alternate levels of care (ALC) pressures. This requires an approach tailored to the unique needs of older adults.
Several senior-friendly care (sfCare) principles implemented by the Geriatric Inpatient Consultation Service at Health Sciences North helped facilitate a safe discharge home for a frail 93-year-old patient admitted during the pandemic. sfCare is essential, evidence-based and foundational care that needs to be woven into the fabric of care for every older adult across every part of the healthcare system, especially during a pandemic.
"COVID-19 has led to previously unseen rates of social isolation and functional decline for seniors, especially those who are frail," noted Dr. Jo-Anne Clarke, Geriatrician and Medical Lead for the North East Specialized Geriatric Centre at Health Sciences North. "As such, evidence-based, timely interventions to reduce functional decline and delirium are essential to maintaining seniors' function and quality of life, especially during hospitalization."
When the patient arrived at the emergency department, she presented with weakness, falls, functional decline and acute onset confusion. Within the first 24 hours of admission, she received a referral to the Geriatric Inpatient Consultation Service and was able to complete a comprehensive geriatric assessment. The geriatric assessor was able to prioritize geriatric conditions and implement several sfCare principles such as managing the patient's pain, initiating rapid mobilization and delirium screening/prevention principles. It was clear that this patient's pain was limiting her ability to move and participate in her care. As such, an assessment by a care of the elderly physician was also essential.
Once her pain was better managed, the patient was able to participate in ambulation/balance and strengthening exercises with the reactivation workers, partake in completion of her activities of daily living and was also able to sit up in a chair for all meals which benefited her cognition.
Early facilitation of mobilization and encouraging one's independence are effective methods to prevent avoidable functional decline in older adults admitted to hospital (Regional Geriatric Program of Toronto, 2020). Immediate implementation of these sfCare principles allowed this frail 93-year-old patient to regain her independence, improve her quality of life, decrease her length of stay and return home with assistance from community services and her family.
The Regional Geriatric Program of Toronto offers a host of resources tailored to hospitals such as an online self-assessment tool with report card, implementation toolkit, and the sfCare learning series. Hospitals can use the Getting Started with sfCare Roadmap to plan their sfCare implementation.
References:
Regional Geriatric Program of Toronto (2020). Policy Brief: Guidance for hospital senior leaders as they redesign care in pandemic times and beyond. It’s time to Change the way care is provided in hospital for older adults with frailty, Senior Friendly Care, 1-4.