With the goal of continuous quality improvement, a health system created programs and tools to provide care for older patients that focuses on advance care planning, cognitive decline, and how to ensure safe transitions.
The goal is interprofessional geriatric care and providing good care to complex, hospitalized older adult patients, says Maureen Dale, MD, assistant professor and director for education and clinical care of the Geriatric Fellowship Program at the University of North Carolina at Chapel Hill.
One example is staff training on dementia. UNC’s Hillsborough campus, which includes a geriatric inpatient unit and geriatric ED, trained every employee — even cafeteria staff — on geriatric patients and how to provide dementia-friendly care. Employees complete online modules and attend one in-person, hour-long class on dementia-friendly communication techniques led by a geriatric nurse practitioner. For instance, staff learned how to introduce themselves when they enter patients’ rooms and how to calmly reorient patients.1
“We trained dementia champions and other hospital staff members to continue to give the session to new hires as time went on,” Dale says. “They could continue the training and put together a dementia-friendly training manual for [educators] to use to teach those sessions.”
Another tactic is to use a discharge summary template with every geriatric patient. The template can include questions about advance care planning. It also can be embedded in a health system’s medical record.
“Our template allows providers to fill in information about a patient’s functional status, what activities of daily living and instrumental activities of daily living they are able to complete on their own or with assistance,” Dale says. “There’s a section on their cognitive status. If they’re delirious during the hospital stay, we include that. If we did any cognitive testing to look for signs of cognitive impairment or dementia, we include that in the template.”
The tool includes questions about whether a patient has designated a healthcare decision-maker and any goals of care or advance care planning.
“We use the template as our standard discharge summary template for all patients on geriatric service,” Dale says. “It’s not always that the template is fully or thoroughly filled out, but our goal for our service is for each patient to have a comprehensive geriatric assessment when they’re in the hospital.”
The template also can be filled out over time, rather than in one 20-minute documentation session. “It’s a document we can add to throughout the patient’s hospital stay, so we don’t fill it out all at once,” Dale says. “As we get more information from the patient and caregiver about the patient’s functional status, we fill out the functional piece and the cognitive piece; it can be built throughout their hospital stay.”
Another way to provide optimal care to geriatric patients is for case managers and providers to remember that older adults often have a caregiver or partner who is helping manage the patient’s care.
“Often, it’s someone who is older, and we should keep in mind any sort of transportation or functional limitations that could limit their ability to do some of the follow-up we’re asking them to do,” Dale explains. “The people in their lives and what they need help with is increasingly important as time goes on.”
- Castellucci M. UNC Health Care trains staff to treat dementia patients. Modern Healthcare. Oct. 19, 2019.