Critical Path Network

Listen to your elderly patients for plan of care

Keep in mind they need special considerations

As Karen Morgan, RN, MSN, CCM, RN-BC, makes rounds with the rest of the treatment team on Danbury Hospital's heart failure unit, she uses her knowledge as a certified gerontology nurse to point out the special considerations that the elderly patients on the unit may need.

"Patients need to feel like somebody is listening to them. These patients haven't always been 80 years old or older. If we pay attention to what they are saying, the input of elderly patients can be very valuable and can help with some of the issues in daily care," she says.

For instance, it can be helpful to ask patients how they have been transferring from the bed to a chair, rather than showing them how to do it.

"Interaction and inclusion is very important. Older patients can help us determine what will work best for them," she says.

Hospitals operate on a specific schedule, and it's often hard for the elderly to adjust, Morgan says.

"Doctors come in at certain times; meals are at a certain time; medications are at a certain time. We forget the fact that patients had a routine when they came into the hospital, and with the elderly, it's hard for them to adjust to changes," she says.

Younger people tend to speak up if they get hungry before their tray arrives, and they don't have a problem pushing the call button if they need something, she says.

"Many elderly patients feel like they don't have a choice. They have to go along with the routine and not bother the nurse. If they need to change position or something worries them about their medications, they are likely to wait until a nurse comes in before asking," she says.

It's important to round on patients frequently instead of waiting for them to voice their needs, she says.

The treatment team may need to make special accommodations to ensure that they get adequate nutrition and calories.

"Elderly patients are not necessarily big eaters, but that doesn't mean they won't eat. Instead of just assuming the patient will not eat, I encourage the rest of the team to explore individual eating habits so we have insight that we can act upon," she says.

For instance, if someone cuts the crust off a sandwich and cuts it into squares, seniors may eat it. If they won't eat what's on their tray, offer a bowl of soup, she advises.

She often suggests putting nutritional supplements into a cup with a lid and straw so the patient doesn't have to struggle with spilling it.

Be alert for the effect of multiple medications on the elderly patient's system, she adds. For instance, watch out for a patient's reaction to sleep agents that may not adversely affect younger patients, she adds.

"Elderly patients are very sensitive to even the smallest doses of some medications. Medication adjustment is often a big issue. I have become much more aware of drug interactions and reactions in the elderly and carry a medication book with information on the drugs and recommended dosages so I can alert the physician if it appears one of my patients is having problems," she says.

For instance, one of her patients was taking several medications for heart failure and, while in the hospital, was started on a drug for an enlarged prostate.

"After a couple of days, he began to have symptoms of dementia and it got to the point that he needed a sitter. Before he was hospitalized, he had been a professional man with normal behavior according to his wife. It didn't add up," Morgan says.

When the team analyzed his medications, they determined that the prostate drug was the only one that was new. They took him off the drug and after three days, his behavior started to normalize, Morgan says.