Part 1 - Functional decline

Older people and their families share their personal stories about the physical and emotional impact of being in hospital, particularly related to their loss of independence.

Over 50% of patients are older people.
Too often functional decline is a consequence of the care patients do or don't receive.

Music and Professor Barbara Workman speaking:
"This presentation is a complement to the Department of Healths Best care for older people everywhere: Toolkit. It presents the issues and it provides insights and strategies from clinicians, carers and most importantly, older people who have experience of hospital care."

Dora - Clinical resource nurse
Functional decline is huge, and it's something that unfortunately we see a lot in nursing. For me it's when we as health carers haven't done our job and a patient has come into us in a healthier state that when they leave us. Decline in their functional status: the things that they used to be able do that they can't do anymore.

Susan Clinical Nurse Specialist Continence.
It's really important that, you know, we look at it in that really holistic way. That we don't just look at the mechanics of "oh this person can still walk", can this person feed their dog? That may be really important to them. Being able to enjoy your life, being able to choose what you have to dinner, being able to socialise with your friends, being able to still connect with your community.

Ray patient hospitalised because of stroke
Suddenly I found that, you know, when I had this stroke, here I was in hospital and suddenly finding loss of use of my right arm and right leg and the face, and I thought 'wow, what am I doing here?' and I had visions of being in a wheelchair forever, and it wasnt until the next morning when I was totally paralysed down the right side, that a doctor said to me "oh no, you can get 80-98% recovery" and I said "really?" and so suddenly I was enthusiastic and motivated to do what I could about getting better.

Maria, carer for her mum
Mum was just deteriorating, really, in front of our eyes. We just couldnt work out what was wrong with her, her pain levels, she wasn't eating, she was starting to have falls, and just, just a decline. Ummm, we contacted her doctor, and hed been very good, very supportive, but we still didn't know what was right, and then one day I looked at Mum at home, and I thought, I couldn't get on top of the pain; it had really gone through the roof and I rang and they said "look, yeah, you need to send her in".

Lyn Hilda's daughter
She was fit as anyone could be, really, very fit woman, and she was here, just doing some gardening one morning. OK. By the afternoon, she had pains in the stomach, she rang the ambulance, by the next morning they didn't realise she had blood clots that went to her stomach. She's lost half her small bowel, third her large bowel, um, so things went down from then. She's really, you could say house-bound. All her bowls that she used to do, or go out shopping on her own if she could, just walk up the street, that cannot be done anymore. Once a person's lost um their independence, thats when they start to go down. So that's where you've really got to be very careful and make sure she does get her independence back.

Marilyn Multiple hospital stays
From '97 on, umm, I was in hospital, I'd say more than I was home, up until about 2001. I sat in the sun room one day, and there was a little old lady tearing up paper and throwing it into a bin, and I thought "is that going to be me??" because I felt Id lost my identity. I'd lost who I was. I couldn't concentrate anymore and yet no one ever talked to me about it. What was the reason for that? Would I get any better? Umm. Did I have a future?

Ray patient hospitalised because of stroke
Speaking from experience, it's a, a frightening experience to be suddenly subjected to suffering a stroke and then thinking which way is up? You just don't know which way is up.

Marilyn Multiple hospital stays
The feeling you get is that you're not a person at all; youre just another thing thats in there, or another condition that you're there, for them to treat and get better and get home quickly.

Lyn Hilda's daughter
Just, just another part of the conveyor belt, something that they've got to do, theyve got to do that room, and that room, that room, and then go back again and start all over again. Just a - a number.

Ray patient hospitalised because of stroke
Here I was in this unknown territory, um, following the stroke, and couldn't help myself to get out of bed, and couldn't do anything. Um. The care was good, but the um one thing that did stick in my mind was the horrific experience of needing to be lifted by a crane, with the big strap around your body and lifting you up by the crane to put you on to the wheelchair or the commode chair, and this was most embarrassing in a ward where there are other people. Um when they lift you in the crane, you have no pants on and everything hangs out underneath, and I thought, "My goodness, I've got to get out of this crane lifting".

Maria - carer for her mum
When she broke her hip, umm, I wasn't notified either, it was really hard. Mum broke it, I think it was first thing in the morning, at breakfast time. Her buzzer had been taken off her because she was ringing the bell too often. And I think the reason why she might have been ringing the bell too often was one, her pain. It still was not under control, but that generation wouldnt voice up and say, you know, I've got pain, you know, they'd wait and wait and wait, and that was mum.

Ray patient hospitalised because of stroke
Being moved from one ward where I had the drawers where you put your pyjamas and goodies and things, those drawers were on my left in the first ward, and then they changed me to another ward, and thats fine, they wheeled me in and put me in this bed, but when the drawers came in, they were placed on the right, and of course the right side didnt function and when I tried to lean over to get my pyjamas, I fell out of the bed.

Hilda Hospitalised for 9 months
If you ring a bell and that, your nurse is busy, you can be a half hour waiting for that, for her to answer. When theres others standing around it's, it's not my patient. I did not like that.

Lyn Hilda's daughter
They don't realise that um if the meal is not close enough, they can't eat it. They can't open the packages, they cant eat it. And no one comes in to say "Oh, why haven't you ate (sic) this, it's still sitting there." Just take away the tray. Who cares?

Maria carer for her mum
Sometimes I'd walk in and you know, um "have you had breakfast, Mum?" She said "No, the tray's arrived and it's gone". And she hadn't had enough to drink and things like that, so ... there was the pain, there was the urinary tract infection, and all of that, um, I think, didnt help the situation with mum becoming distressed and ringing a bell.

Narration: music, graphics of people in hospital

As evident in the patient and carers experiences, there is clearly room for improvement in the way we care for older people. The evidence shows that older people can be worse off because of the hospital environment, and the care they do, or do not, receive. In addition to their presenting condition, hospitalised older people often experience, and are more susceptible, to under-nutrition, dehydration, falls, pressure injuries, pain, incontinence, depression or delirium. However, we can make a difference. There are many evidence-based strategies you can incorporate into your practice to minimise risks and improve outcomes for older people. For example, you can ensure that patients are adequately nourished and hydrated, with meals and drinks accessible. That their call bell is in reach, that their pain is regularly assessed and managed, that incidental activity and independence is promoted during their stay, and their care is tailored to their usual routines, goals and needs. The Best care for older people everywhere toolkit has been developed to support you to be person-centred in your practice. For access, go to the website.