1 How can the hospitals become a good place for older patients? Virpi Honkala Raahe Health Area

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RAAHE HEALTH AREA, FINLAND

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5 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

6 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

7 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

8 Senior preventive study  physical condition was fairly good  plenty of friends and hobbies (95 %)  continuous long history of work  strong people despite of hardships in life  happy with life  enthusiastic about changes

9 Senior preventive study  blood pressure: 39 % > 130/85 – medication 48 %  BMI: 9 % 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

10 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

11 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)

12 Senior in hospital unsuccessful 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

13 Senior in hospital unsuccessful 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

14 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

15 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

16 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

17 GOOD AGEING body condition values and philosophy of life social conditions openness imagination activities for the brain