Home' Australian Ageing Agenda : AAA Jul-Aug 2012 Contents The LiftCare Bed Company www.liftcarebeds.com 1300 132 736 email@example.com
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building initiatives for residential and
community care nurses in undertaking
certain procedures, such as changing supra
pubic catheters or administering pain relief.
But improving access to primary and
community care still doesn't address the
whole problem. Elderly people will still
require hospital treatment so improvements
to the hospital experience for elderly
people and better systems for dealing with
their specific needs are also important.
Royal Brisbane and Women's Hospital
(RBWH) has been something of a
trailblazer in Australia in the way it deals
with frail elderly people coming into the
emergency department (ED).
It's Hospital in the Nursing Home
program, is located within the ED but staffed
by experienced aged care professionals.
"Our aim is to improve the experience
of the elderly person coming into the ED,"
says Rhonda Purtill, who established the
unit in 2006 and still leads it, including
running an increasingly successful annual
conference attended by aged care clinicians
from all disciplines, Australia-wide.
The role of the unit is to work with the
elderly person and their family, the aged
care provider, the GP and other parties to
optimise the hospital experience. There
are three arms to the service -- supporting
elderly people in the ED; an outreach
service to residential aged care services
to support complex clinical care and
coordinate access to medical services; and
an inpatient support role for those who are
admitted to the hospital.
The aim of the inpatient support role is
to reduce length of stay, improve decision-
making and communication and provide
advocacy for the older person.
"We provide timely care, support to the
people delivering care; we try to alleviate
the stressors on the residents. We improve
communication between the GPs and
ED consultants, the aged care staff, the
support nurses etc."
She says mutual respect and good
relationships between stakeholders is
Bucking the system
Director of geriatrics for Mount Sinai and the University Health Network Hospitals in
Toronto, Canada, Dr Samir Sinha, was a presenter at a health policy summit hosted by the
Nuffield Trust in the UK earlier this year.
He told the conference that current models of healthcare are not designed to cope
with the problems of an ageing population, that the escalating costs in acute care are
increasing fastest for older adults and that new cost-conscious healthcare models were
required to meet the complex needs of older patients.
"Studies have demonstrated that focused models of care that consider the unique
needs of older hospital patients in emergency, inpatient, outpatient, community and home
care settings can improve overall outcomes while at the same time reducing lengths of
stay, admissions, readmissions, and inappropriate resource utilisation," he says.
One of the biggest problems is that the hospital model was developed at a time when most
adults tended not to live past 65 and therefore were not generally living with chronic illnesses.
"They usually only had one active problem bringing them to hospital. A model focusing
on treating one issue at a time disadvantages older people who often present with many
Dr Sinha said there was an urgent imperative to develop comprehensive, evidence-
based care strategies to improve the care of older adults.
In 2010, he said, Canada's Mount Sinai Hospital in Toronto became the first acute care
hospital in Canada to make geriatrics a core strategic priority for the entire institution.
"It developed a new model of comprehensive acute care for elders -- the ACE strategy --
focused on always delivering older patients the right care, in the right place at the right time."
The model uses an interprofessional team-based approach that seeks to identify and
deal with issues early. Dr Sinha said its strength relies on the partnership between geriatric
medicine, geriatric psychiatry, primary care, palliative medicine, and emergency medicine
programs and it has achieved impressive results quickly.
"The hospital's overall quality of care has improved; it has reduced the need for and
lengths of admissions, decreased readmissions, while increasing overall patient and staff
satisfaction. In short, patients are returning home in better health and staying there longer.
Other hospitals in Canada are following suit given that 60 per cent of hospital expenditures
there are directed at the older population."
There is also a lot of passion on all
sides. As RBWH's deputy director of
emergency medicine, Dr Bill Lukin
said at this year's conference, "Is acute
care ever the right place for aged care
residents? No high care resident should
have to come to hospital to get the care
they deserve." n
AAA | JULY -- AUGUST 2012 | 53
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