Maximizing health for our ageing population
The Emergency Department team at the Royal Victoria Hospital is currently testing Elder Friendly initiatives. Pictured above, left to right: Pierre Chassé, Joseph Denitis, Brendon St-Denis, Danièle Lamarche, Sophie Veilleux, Lourdy François, Stephanie Sereda, Madeleine Lemay and James Bulchand. Absent: Patricia Barassi, Anita Petzold and Dr. Josée Verdon.At the McGill University Health Centre (MUHC), over 45 per cent of patients were 65 years old and over last year. This number will only continue to climb.
The growth in our ageing population can be seen as a success story for public health policies and for socioeconomic development, but it also challenges society to adapt to maximize the health of older people. At the MUHC we are doing our part by ensuring we get it right as we transition to the New MUHC at the Glen and Montreal General Hospital sites in 2015.
“In Quebec, the Ministry of Health developed a program called the Approche adaptée à la personne âgée (AAPA). All hospitals in the province are being asked to implement the guidelines of this project,” says Rita Crisante, management advisor of the Development of the MUHC Elderly Friendly Project.
The four dimensions of AAPA include:
- Clinical (revising care processes to decrease the risks of delirium and functional decline during hospitalization of older patients)
- Physical environment (design strategies of care space to promote autonomy)
- Social behaviour climate (reducing ageism towards the elderly)
- Adapting policies and procedures to facilitate continuity of care
AN ELDER-FRIENDLY DESIGN
The New MUHC at the Glen site will be an elder-friendly hospital. To ensure the safest of environments for this segment of our clientele, our interior design team followed a set of guidelines and incorporated specific design elements that will make a visit to the hospital safe.
THE GLEN IS UNIVERSALLY ACCESSIBLE.
- Grab bars will be installed across the site in patient washrooms and rails will be installed in hallways and other public spaces (at different heights) for people with limited mobility. In addition, seating will be provided throughout the public areas to allow older patients and visitors to rest at frequent intervals.
- To avoid tripping and falling there will be no thresholds or steps at entryways and into patient washrooms and showers.
- Floors in showers and bathtubs will be anti-slip.
- All patient rooms will have adjustable lighting (dimmers) and nightlights will be installed near bathrooms.
- Full-spectrum lighting will be installed in all patient rooms to avoid glare.
- Lights will be positioned over wayfinding signs to make getting around the Glen easier.
- There will be automatic door openings for main entrances, hallways and doorways.
- Contrasting paint colours will clearly define: doorways, baseboards and floorboards.
“Some of our front-line staff will have access to 20 hours of e-training relating to the quidelines,” says Crisante. “I think there are many things to be learned. For example, The Canadian Malnutrition Task Force identified that a large number of older patients arrive at hospitals malnourished. We need to create awareness around this and readjust our clinical practices, as well as ensure that the physical design provides the appropriate environment. The developmental needs of the older patient requires a paradigm shift in approach to care similar to what has been done for the pediatric population.”
So far this year, AAPA guidelines have been implemented as pilot projects in the Ross and Medical Pavilions at the Royal Victoria Hospital and in the Emergency Departments of the Montreal General and Lachine hospitals.
A GAP analysis (looking at the gap between current practices and evidence-based practices provided by the Ministry) will be performed.
In all units, physical design will also be considered, such as making sure corridors are clear and carts are on one side, among other changes. At the Glen, the physical surroundings will be adapted from the start (See sidebar, “An Elder-Friendly Design”).
The social climate will come with time and sensitization. Crisante is currently working with Human Resources to increase this awareness through a module of orientation for new staff. And policies and procedures will be the final implementation. It is expected that the MUHC will be fully “Elderly Friendly” when the Glen site is opened.
“Besides reducing length of stay, reducing the number of patients requiring rehabilitation or long-term care and increasing survival rates, these adaptations will contribute to patient safety and quality of care,” says Crisante. “And as we all would want for our ageing family members—overall improved quality of life.”