Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 316

Frailty and comorbidity bring many challenges for healthcare systems, the greatest of which is ensuring integrated care with seamless communication and transition between services, allowing congruent treatment plans and optimal outcomes. Transitions of care, particularly the interface between primary and secondary care in acute hospitalization (at both admission and discharge), can be particularly problematic. This is a critical phase in the healthcare journey of older people, and there is a risk of problems related to health and/or care immediately after transition. Twenty percent of older people face adverse event in the transition phase, 60% of which are preventable.⁵⁶

The goal of care for a frail person in the hospital is not just to treat their acute illness but also to promote maximum functional recovery and independence – in other words, to prevent functional decline. Achieving this goal requires systems to be set up in the hospital so that patients who are frail and at risk of functional decline can be recognized and treated early to prevent adverse outcomes. However, this does not always occur, particularly when older people are admitted (justly) to areas or departments where systems are geared more toward the care of younger, fitter people (such as surgery).

Several other systems factors may contribute to adverse events in the care of older people in the hospital. These can give rise to poor communication: for example, inadequate procedures for handover for medical and nursing staff, either between themselves when shifts change or between disciplines when decisions are made. Systems factors may also limit good communication: for example, time constraints and pressures due to the volume of work may not allow healthcare professionals to take the time required to assess an older person thoroughly, decide on a good management plan, initiate it, and communicate all of this effectively to the patient, their relatives, and other staff caring for them. This means even if an individual has good communication and clinical reasoning skills, the system does not always allow them to be realized to their maximum potential in optimizing patient care.