For frail and elderly patients, remaining in an acute hospital setting is not ideal

OLDER PEOPLE are the biggest users of acute hospitals and while the medical, surgical and specialist services available in these hospitals are of utmost importance, the busy environment and the focus on intensive medical and immediate post-operative care isn’t always conducive to full recovery.

In fact, once the acute medical complaint has been dealt with, older people often do much better in a well-organised and caring rehabilitative setting.

Still fragile, good care at this stage can improve their quality of life immensely and a rehabilitative setting offers a more holistic treatment programme including physiotherapy, occupational therapy, advice on diet and even home visits.

The Royal Hospital Donnybrook, Dublin is one non-acute hospital which has recently set up a short-term post-acute rehabilitation care unit linked to St Vincent’s Hospital, Elm Park, Dublin.

Since it opened in July 2011, more than 110 patients have used the facility and more than 90 of them (average age 81) have returned home after about six weeks. The service is available to public patients.

“The reality is that for frail and older patients, remaining in an acute hospital setting is not ideal and can often lead to a deterioration of their health and ultimately result in them entering long-term care,” says Dr Lisa Cogan, geriatrician and medical director of the Royal Hospital Donnybrook.

“Some older people don’t regain their full physical and mental capability after an acute medical illness. The focus of this unit is to provide rehabilitation in a non-acute clinical environment over a short period of time so that as many patients as possible are able to return home.”

Una Blake was referred directly to the Royal Hospital from the emergency department of St Vincent’s Hospital in January. She had fallen on the street while in Dublin city centre, returned home on public transport but subsequently fell again in her home in Milltown.

When she attended the emergency department at St Vincent’s hospital, the medical team there didn’t find any broken bones and they referred her to the Royal Hospital Donnybrook for rehabilitative care.

“I was in terrible pain when I first came here,” says Blake, who was kept for six weeks at the Royal Hospital before returning home.

According to Cogan, “Her pain was due to compressed fractures in her spine which were impinging on her nerves but we also found a number of other problems which needed to be dealt with.”

These included a sacral ulcer (pressure sore) which needed wound care and the use of an inflatable cushion for sitting and a special mattress for lying on. “We also found that she was nutritionally in a poor state with loss of muscle strength,” adds Cogan.

“I put on weight while I was here . Normally, I have a very good appetite but I hadn’t been eating well before I came in,” says Blake who returned to the hospital to talk to this reporter about her stay there.

Olivia Sinclair, head of nursing at the Royal Hospital, says the twice-weekly multidisciplinary meetings are hugely important so that all aspects of each patient’s care can be checked and reviewed.

“All patients are assessed when they come in and programmes with weekly goals to deal with pain, function, diet, etc are put in place,” says Sinclair.

In Una Blake’s case, her medication was also reviewed on admission and a pain-management programme put in place.

The Royal Hospital Donnybrook has recently added an “activity of daily living suite”, which has a kitchen, bedroom and bathroom – all fitted with adaptive equipment for patients to try out before adapting aspects of their own homes.

“The value of the kitchen for example is that we can see how the patient manages with cooking and if there are any safety issues – if the hob is left turned on, for example, we can advise them to move to microwave meals or organise meals on wheels or a carer who cooks for them,” says Cogan.

Patients who are well enough are also encouraged to dress each day and have their meals in the communal dining room.

“All the emphasis is on the patient,” says Blake, who had home help organised for her when she returned home. “I was sad leaving and facing home but I owe it to the staff here that I am as well as I am today.”