Ruminations: A New Hospital Unit Concept In Elderly Patient-Care

Geriatric healthcare team members with patient and family

Queensway-Carleton Acute Care of the Elderly unit

"We know the longer they [elderly patients] stay in [hospital] emergency departments, the poorer the outcomes."

"An older adult loses ten percent of their muscle mass for every day they stay in bed. For every day in bed, we say it's going to take two days to recover that strength."

"That's the first thing people tell us about if they've come from another ward. That they're sleeping better. If you can't get them to sleep well, you can't get them better."

"Someone would come in with an acute heart attack. We put them in bed and we would make them sicker. They'd lose muscle strength. We gave them medications that maybe weren't the ones we should use in an older adult. We got them confused. We got them disoriented. The heart condition stabilized but at the same time we destabilize everything else."
"At the end of the day, we have patients who are still dysfunctional and we can't get them back home."
Cathie Gray, clinical nurse specialist in geriatrics, Queensway-Carleton Hospital, ACE unit, Ottawa

Well, isn't that innovative? And isn't it about time? Who are society's most vulnerable? The very young and the very old, all the more so when they're ill and in need of intensive medical care. Acknowledging that obvious condition as a fact, stand-alone hospitals dedicated to the care of sick children have long been established and have acquired an outstanding reputation for catering to the needs of the young, medically, practically, emotionally.

Now, one hospital in Canada's national capital has set out to do the very same for that other vulnerable demographic; the ill elderly. And they've designed their new unit as a practical alternative to placing the elderly among the general hospital population requiring sensitive health care, with a focus on just what works best for the elderly. Employing, in the design common sense and simplicity.

Lacking the ease of balance and muscular energy of younger adults, this facility dedicated to the care of the elderly has non-slip and non-glare floors. The corridors are wide and cleared of obstacles with wheelchairs in mind, with handrails for support and padded seating arrangements installed in the wall recesses at regular intervals where strolling patients encouraged to exercise themselves and walk about, can sit and rest.

The unit, purpose-built and newly established, has 34 beds. It is the second such facility in the Province of Ontario. When the hospital emergency department is confronted with a new admission a swift assessment is undertaken to determine whether the new presentation represents someone who would benefit from a stay in the newly opened unit.

Queensway-Carleton Acute Care of the Elderly unit

The rooms, mostly private with some semi-private, feature large windows where the sun can illuminate the room in a spirit-lifting way, and clearly defining night and day. The walls are colour coded aiding patients in identifying their way back to their room from walkabouts in the corridors. The unit's lights are placed on dim mode from 9 p.m. to 7 a.m., with telephones placed on vibrate mode.

Beds are designed so they can be lowered at night to knee height with pads placed along their lengths in recognition of some risk of the elderly falling out of bed. The purpose and goal of the unit is to ensure that patients recover quicker, their hospital stays shortened. The average length of stay in the unit is nine days. Family is encouraged to be involved so visiting hours are any time, including around-the-clock stays if desired.

Family members are provided with nurses' cellphone numbers and invited to call for updates at any time. Since roughly 14 percent of the Canadian population is now over the age of 65, with their numbers expected to double in the next two decades, it makes eminently good sense to establish this kind of elderly-specific environment in a hospital.

Staff offices in the unit are also designed in a very particular way; they are uniformly cramped and uncomfortable. Behind that discomfort is the intention to promote physicians, nurses, social workers and therapists to remain on the ward, alongside the patients. "We don't want people hiding in their offices. Geriatrics is a team sport", explained nurse Gray.