212How ‘Older-Person-Friendly’ is our General Medical Ward? A Cross Sectional Study and Pre-Intervention analysis

Abstract

Background: Care of the acutely ill older person utilising Comprehensive Geriatric Assessment (CGA) is advocated by The National Clinical Programme for Older People which also recommends the provision of their care on the Specialist Geriatric Ward (SGW). We present our review of how appropriate a general medical ward is for the care of older adults as part of a pre-intervention analysis. Method(s): A cross sectional study of older admissions on a general medical ward over a 9 day study period was carried out. Demographic details including age, living arrangements and reason for admission were collected. Patients were asked about their experience of the ward and asked to rate out of seven, with higher scores indicating greater satisfaction. A daily 4AT was carried out to assess for delirium along with a daily nursing report to assess sleeping habits, new incontinence, falls, delirium, and use of sedation. Noise levels were recorded daily using the 'Decibel X' mobile app. Result(s): 21 patients were include. Mean age 78.2 years, 57% female. There was a high prevalence of baseline visual impairment (81%) and hearing impairment (33.5%). Mean Charlston Co-morbidity Index score was 5 and 47% had a pre-existing diagnosis of cognitive impairment. Sleep disturbance occurred in 62% of patients, 29% experienced an episode of delirium, 29% experienced new incontinence. Mean satisfaction level score was 4.6/7. Noise levels were higher on larger wards; 13 bed ward (mean 65.4 dB), 8 bed (mean 64.4 dB), and 4 bed (61.3 dB). Conclusion(s): Our data indicates that the ward environment for our older patients is suboptimal. There was a high rate of delirium, incontinence and sleep disturbance, all associated with a bad prognosis. Previous literature suggests that appropriate ward environments are associated with reduction in such events and improved outcomes for patients. A multimodal intervention is planned on the basis of these data.