Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 321

Technological advances are also making it possible to redesign systems of care for older people with the aim of providing more targeted and integrated health and social care. For example, the rapidly growing field of telecare has made it possible for older people with sub‐acute problems to be cared for in their homes, in ‘virtual wards’, thereby avoiding unnecessary hospital admissions.

In the hospital, much effort has been made in recent years to implement new ways of caring for acutely ill elderly patients to minimize functional decline during hospitalization and subsequent rehabilitation. For example, it is now common practice for most hospitals in the UK to have an orthogeriatric service to ensure optimal medical care from admission to discharge for elderly patients who have sustained a fractured neck or femur. Stroke units are another example of how specialist care with focused, immediate rehabilitation and anticipation and swift recognition of complications can improve outcomes and reduce hospital‐acquired complications such as functional decline.

In general acute geriatric medicine, it has been shown that providing specialist care environments with staff who are interested in caring for older people and who have had relevant specialist training can also prevent the development of the geriatric syndromes in the hospital. An example is the Acute Care for Elders (ACE) unit, in which a prepared environment, interdisciplinary collaborative care, multidimensional assessment, non‐pharmacological prescription, medical review, home planning, and transitional care combine to improve a range of outcomes including improved functional status, lower risk of nursing home placement, and higher levels of patient and professional satisfaction with care.⁶² This system of care, tailored toward the older person, also reduces other errors such as inappropriate prescribing.

The transition of care from hospital to home is a complex process involving a multitude of components. As a result, significant numbers of adverse events related to patient safety take place during this phase. A valid and reliable tool is essential to evaluate interventions aimed at improving transition care. Although many tools are available, a recent systematic review found no validated instrument that assesses all aspects of transitional patient care.⁶³ The Care Transition Measure (CTM) is widely used in the US, while the Partners at Care Transitions Measure (PACT‐M) was recently evaluated in the UK.⁶⁴