1 How How can the can the hospitals become hospitals become a good place for a good place for older patients? older patients? Virpi Honkala Raahe Health Area
Dec 29, 2015
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How How can the hospitals can the hospitals
become a good place for become a good place for older patients?older patients?
Virpi Honkala
Raahe Health Area
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Ratio of over-60sto the population
aged 20-59 inthe enlarged EU
RAAHE HEALTH AREA, FINLAND
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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
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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
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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
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Senior preventive study
physical condition was fairly goodplenty of friends and hobbies (95 %) continuous long history of work strong people despite of hardships in
lifehappy with life enthusiastic about changes
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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
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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
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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)
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Senior in hospitalunsuccessful 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
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Senior in hospitalunsuccessful 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
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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
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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
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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
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GOOD AGEING
body condition
values and philosophy of life
social conditions
opennessimagination
activities for the brain