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How can the hospitals become a good place for older patients? Virpi Honkala Raahe Health Area 1 Ratio of over-60s to the population aged 20-59 in the enlarged EU 2 RAAHE HEALTH AREA, FINLAND 4 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 5 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 6 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 7 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 8 Senior preventive study blood pressure: 39 % > 130/85 – medication 48 % BMI: 9 % < 22, 28 % >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 9 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 10 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) 11 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 12 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 13 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 14 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 15 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 16 body condition values and philosophy of life social conditions activities for the brain imagination GOOD AGEING openness 17