Acute care and older people: challenges and ways forward

Abstract

Objective: This article aims to (a) suggest ways in which acute hospital environments might be modified to better meet the needs of the older person and (b) question whether options other than acute care should be canvassed for older people.

Setting: Acute hospital settings.

Subjects: Older people and people with cognitive impairment

Primary argument: Older people are large consumers of acute hospital care, and acute hospitals are known to pose significant risks for this vulnerable population. Such risks include delirium, falls, restraints, drug side effects, and general de‑conditioning entailing loss of function and independence. Eight dimensions of person‑centred care are presented to promote assessing and meeting the needs of older people in acute care. Alternatives to acute hospital admission are also suggested, such as developing ‘older people centres’ to which older people could be admitted for triage in older‑friendly environments staffed by geriatric experts, places in which their multidimensional care needs could be better met.

Conclusions: As an alternative to acute hospital admission, ‘older people centres’ could be developed to which older people could be admitted for triage in older‑friendly environments staffed by experts in care of older people. In the mean time, why not provide a balanced approach that provides some environmental adjustments for older people, core knowledge and skills for all staff, and access to gerontic expertise in the acute hospital care of older people.