Clinical factor | Goal | Examples |
---|---|---|
Cognition and/or disorientation | Older people-friendly environment | Appropriate lighting, clear signage, clock, calendar |
Frequent orientation | Introduce oneself (‘Hello My Name is…’),26 photos of family/memorabilia at bedside, empower whole team approach | |
Cognitively stimulating activities | Therapy, volunteer befrienders, music consoles27 | |
Access to family | John’s campaign to increase ward access to care-givers28 | |
Dehydration and constipation | Adequate hydration | Volunteers to sit and eat with patients at mealtimes, supplementation of intravenous or subcutaneous fluids if required |
Consideration of comorbidities in fluid status | Regular assessment for fluid overload | |
Regular bowel movements | Regularly asking about bowels, if necessary rectal exam to exclude impaction | |
Hypoxia | Optimisation of oxygenation | Spacers for inhalers or nebuliser adjuncts; titrated oxygen therapy |
Infection | Active search for and early treatment of infection | |
Avoidance of unnecessary catheterisation | Consider monitoring urine output via other means | |
Infection control | Use antimicrobials with low risk of C difficile, and eradicate MRSA in at-risk patients | |
Immobility | Early mobilisation | Early discharge with enhanced home care teams where available29 |
Access to walking aids | ||
Pain | Regular assessment for pain | Assess non-verbal signs of pain, eg using the Abbey Pain Scale30 |
Appropriate analgesia | ||
Exclusion of hidden sources of pain | Routinely examine for pressure sores, back pain and bladder retention | |
Medication review | Medicine consolidation | Review risk/benefit balance of primary and secondary prophylaxis |
Nutrition | Well-fitting dentures | |
Adequate nutrition | Consider dietary supplements, vitamin D deficiency | |
Safe swallow | ||
Sensory impairment | Quiet at night | Avoid evening caffeinated drinks, schedule medication/interventions around patient’s natural sleep cycle, reduce noise to a minimum at night |
Hearing aids that work and spectacles that are not lost |
C difficile = Clostridium difficile; MRSA = methicillin resistant Staphylococcus aureus; NICE = National Institute for Health and Care Excellence