Older people are the majority users of Victorian hospitals and health services. NARI's research in this area is driven by a continuing commitment to improve the experience of older people accessing health services and to facilitate the provision of the best possible care and outcomes. This work is enabled by strong links to the Department of Health and Human Services (DHHS), Safer Care Victoria (SCV), health service providers and consumers.
For further information on these projects, please contact Amy Parker: A.Parker@nari.edu.au
What Do Older People (and their carers) Want from their Health Care?
There is currently limited understanding of what older people want or expect when they seek support for their health and wellbeing needs. As a result there is a need to develop robust policies on how older people access care and services across their life trajectory, which is responsive to the priorities of consumers and informed by their expectations.
NARI is developing an evidence-base for the DHHS about what older Victorians (and their carers) want when addressing their health care and wellbeing needs through a series of face-to-face focus groups, a social media discussion (hosted on Facebook) and an online survey.
Acute Models of Care for Older People (AMCOP)
Older people are significant users of healthcare services with nearly 50 percent of multi-day beds in adult hospitals being occupied by someone aged 65 years and over. While many health services have specialist geriatric services within subacute settings, these only account for around 8 percent of hospital care episodes. To date, details regarding the provision of acute care for older people with frailty and/or other vulnerabilities remain largely unknown.
NARI is conducting a series of semi-structured interviews with metropolitan, regional and sub-regional health services across Victoria in order to identify and showcase good practice, innovative models and/or service delivery processes relating to the acute care of older people.
Shared Acute Models of Care for Older People
Older people with multiple co-morbidities presenting to hospital are often admitted under general medical units, making it difficult for them to receive specialist care in a timely manner. Acute shared care models, which involves joint clinical care provided by two specialty areas, offers the opportunity for greater collaboration and a more co-ordinated approach to support the provision of holistic, patient-centred care. Proposed benefits include reduced deterioration, more appropriate risk assessment / management, improved discharge planning and shorter length of stay.
NARI is performing a narrative scoping review to map the literature relating to shared acute medical models of care for older people in addition to conducting individual structured-process interviews with Victorian health services to further understand the local actions in place.
Measuring Functional Decline for Older People in Acute Hospital Settings
Functional decline is widely accepted as a reduced ability to perform activities of daily living due to a decrease in physical or cognitive functioning. While functional decline can occur as early as day two of hospitalisation, the majority of strategies to avoid this hospital-acquired complication are targeted for subacute settings. Given that people aged over 65 comprise approximately 48 percent of acute inpatient admissions, future work needs to focus on maintaining function in the acute hospital setting to improve patient care and outcomes. To date, measurement of outcomes relating to the care of older people in acute hospital settings including functional decline has been based on metrics focused on key performance indicators that assess process and single domains of care. Patient Reported Outcome Measures (PROMs) are tools for capturing the patient’s perspective on the outcomes of their own treatment and care which have been described as having the potential to enable improvement by providing information that can bridge the gap between the clinical reality and the patient world, triggering learning as well as the right next action.
NARI is completing an environmental scan of relevant measures (both quantitative and qualitative) used in the screening and comprehensive assessment process within Victorian health services with ultimate the aim of developing a new PROM to assess functional decline in acute hospital settings.
Department of Health and Human Services ‘Older People in Hospital’ Website
The DHHS ‘Older People in Hospital’ on-line resource was released in February 2016 following a complete review of the evidence base and the addition of a several new topics to the existing paper-based Best Care for Older People Everywhere: The Toolkit. It is a source of information to guide clinicians to provide better care for older people and reduce functional decline in hospital.
NARI is responsible for the ongoing maintenance and support of the website content to ensure that it provides clinicians with evidence-based information that is up-to-date, accurate and relevant in minimising the risk of functional decline.
The Hospital Environment Audit Tool (HEAT): Improving the Environment for Older People in Hospital
The Hospital Environment Audit Tool (HEAT) is an on-line, evidence-based tool developed by NARI for staff to audit their hospital environment. It encourages the user to consider the ways that the environment, including the model of care and policy framework, affects an older person’s mobility, independence and wellbeing during a hospital stay and provides practical strategies to optimise the environment in order to best meet the needs of older people and increase their participation in their care.