Functional decline in hospitalised older people: quality of 24-hour care.

Abstract

BACKGROUND: Older people are vulnerable to functional decline during episodes of acute medical care. Approximately one to two-thirds of older patients are reported to experience functional decline in hospital, which in turn, has been recognized as detrimental to their quality of life, and life expectancy. The purpose of this research was to explore and describe the quality of 24-hour care provided to minimize functional decline in older patients diagnosed with acute medical conditions. METHODS: A single institution case study design, with multi-methods and repeated measures was used. Functional status was measured using the Functional Autonomy Measurement System (SMAF). Two sub-scales of the SMAF: Activities of Daily Living (ADLs) and Mobility, were measured at three time points (2-weeks preadmission; on admission and Time 2; and at discharge). A sub-set of patients participated in 6-hour non-participant naturalistic observations on Day-two of admission. The researcher observed all consenting staff during their interactions with patients and maintained a continuous record of patient activities. RESULTS: A convenience sample of 65 vulnerable older patients aged 70 years and over (Mean age 82.4, SD 7 years) who were admitted to the General Medical Unit (GMU) of a tertiary-referral, metropolitan public hospital in Australia, from 2010 to 2011 were evaluated. Just over half (n = 37, 53.8%) of the patients' experienced functional decline between 2-weeks preadmission and discharge from hospital. Naturalistic observations of a sub-set of n = 41 patients revealed opportunities and barriers to the performance of ADLs and mobility. Nursing staff engaged in high frequency, low duration interactions with patients. Patients self-initiated most episodes of mobility and nurses were most often involved in assisting or supervising activity that was implicit to patients' ADLs. CONCLUSIONS: Integration of the findings demonstrated that older patients' unique vulnerabilities to functional decline were not emphasized in 24-hour care processes. There was a lack of coordination of care to protect and optimize patients' functional status.