The Senior Friendly Hospital Toolkit
Hospitalization can be a pivotal event in a frail senior's life. It can add years and quality to life, or create complications that result in a difficult-to-reverse decline in physical or cognitive function. Without senior friendly processes in place, seniors may also have higher rates of adverse events, surgical complications, and nosocomial infections. Poor outcomes can result, such as increased length of stay, re-admission to hospital, decreased capacity for independent living, and reduced quality of life.
This toolkit provides a collection of resources organized under the domains of the Senior Friendly Hospital framework. The enhanced Processes of Care modules – Delirium and Functional Decline – include a selection of tools that have been rated by clinicians and administrative experts in geriatric care across Ontario:
The Senior Friendly Hospital Framework
The evidence also informs us that a systemic approach to the care of frail seniors, one that considers the influences of the entire care-giving environment, is associated with positive outcomes. Building upon this evidence, the Regional Geriatric Programs of Ontario have developed and endorse a Senior Friendly Hospital framework to promote an organization-wide approach in service planning and care for seniors. The framework has five components:
OS Organizational Support – There is leadership and support in place to make senior friendly care an organizational priority. Hospital leadership committed to senior friendly care empowers the development of human resources, policies and procedures, care-giving processes, and physical spaces that are sensitive to the needs of frail patients
PC Processes of Care – The provision of hospital care is founded on evidence and best practices that acknowledge the physiology, pathology, and social science of aging and frailty. Care is delivered in a manner that ensures continuity within the health care system and in the community, so that the independence of seniors is preserved
EB Emotional and Behavioural Environment – The hospital delivers care and service in a manner that is free of ageism and respects the unique needs of patients and their caregivers, thereby maximizing satisfaction and the quality of the hospital experience
Eth Ethics in Clinical Care and Research – Care provision and research are conducted in a hospital environment that possesses the resources and capacity to address unique ethical situations as they arise, thereby protecting the autonomy of patients and the interests of the most vulnerable
Phys Physical Environment – The hospital’s structures, spaces, equipment, and facilities provide an environment that minimizes the vulnerabilities of frail patients, thereby promoting safety, independence, and functional well-being
Teamwork and Inter-Professional Care in a Senior Friendly Hospital
One of the challenges in providing optimal care for frail seniors in hospital is that their overall health and function is related to many interacting factors in addition to their presenting acute illness. These include the ever changing status of chronic ailments, the complex interaction of multiple medications, the effect of psychosocial factors, the availability of family and caregiver support, and the safety and comfort offered by the physical environment. With this clinical complexity, the problems that frail seniors experience in hospital typically require multi-dimensional solutions and the contribution of multiple health disciplines. Teamwork and inter-professional collaboration are essential skills in a Senior Friendly Hospital.
The management of polypharmacy provides an illustration. In order to promote the safe and optimal use of medications, the team physician should review appropriate prescriptions, the pharmacist should check for potentially dangerous drug interactions, the nurse might advise on appropriate administration routines, the physiotherapist might screen for medication-induced mobility impairments, the occupational therapist might advise on devices to assist memory and dexterity, and the social worker might engage and educate patients and families to promote medication adherence. All the while, the entire team is able to promptly recognize and communicate change and adverse reactions noted during the course of interactions with the patient. While this is a very simplified example, it illustrates an important point: the skills of the entire inter-professional team and effective communication are important enablers of success in geriatrics best practice.
- The development of the Senior Friendly Hospital toolkit is a dynamic process, with updates anticipated to reflect the evolving evidence base in the care of older adults.