The incidence of immunosuppressed elderly patients has increased over the past few years. Hospitals and rehabilitation centers are seeing patients with greater complications, which poses many risks. Patients face the dangers of mass infection, greater length of stay, isolation from friends and family, limited resources, and poor patient follow-up. These potential threats combined with Medicare cuts in an ever-changing health care system are putting our elderly in jeopardy.
Improving patient care is essential to this community by increasing education and providing better preventive programs and follow-up. Many elderly patients are discharged into a rehabilitation setting after spending some time in the hospital due to illness or trauma. Complications can be seen very early and vary from weakness and dehydration to cognitive and physical problems. In order for a patient to receive optimal care, problems need to be addressed accordingly.
Patients’ physiological changes can cause a simple illness to present differently and can make treatment difficult. In rehabilitation, patients require detailed assessments from the rehabilitation team, easy-to-follow instructions, a well-lit environment, minimal noise level, and a keen eye to notice changes in the patient. Evidence-based practice must include continuous education for staff, such as interventions for current disease processes, assessments of current medications and side effects, and an evaluation of support systems and community needs.
Elderly patients who suffer from dementia or delirium can also experience a positive rehabilitation experience by simply minimizing triggers that may cause anxiety. Patients need to feel comfortable in their new surrounding. Reorient the patient often and repeat instructions accordingly. Encourage safety and maintain an open dialogue with the patient and his/her family to enhance opportunities for teaching and learning.
Nurses need to be aware of changes that could cause a patient to become increasingly confused: fever, infection, dehydration, a change in room, poor eyesight, poor sleeping habits, or medications such as antidepressants. Confusion can also lead to falls, an increase in length of stay, and/or lawsuits. Within the past few years, the cost of falls has risen to $30 billion dollars. The statistics are shocking:
- 1 in 3 adults over the age of 65 will be treated for a hospital fall related injury
- 30% suffer complications such as infection and/or death
- By the year 2020, the cost of falls will cost health insurances over $50 billion dollars
Immunocompromised patients may require longer hospitalization and rehabilitation. Premorbid conditions may present differently and can be difficult to treat. Family and caregivers must be taught to watch for signs and symptoms of infection and dehydration. Education is extremely important, particularly current medications and their side effects as well as proper follow-up. Patients can become lost for many different reasons: lack of support, decrease in income, lack of understanding of current disease process, or no means of getting to the doctor. Families must be encouraged in order to have a positive outcome.
Patients who have better access to community services fare better and are more likely to follow-up with doctor visits. They tend to keep a better dialogue with visiting nurses, require less hospitalization, and comply with medications and procedures. These patients gain an understanding of their disease process, identify possible risks, and seek medical help sooner.
Helping seniors remain independent for as long as possible is extremely important to their psyche. Community services range from town to town, availability, and cost. Coordinating care can be tricky, but a case manager is an essential source of information. Caregivers can arrange transportation, meals, social and physical programs, and even group events. Some programs are even specifically geared to gender, needs, race, or religious affiliation.
Staying active and being part of the community plays an important role in health. Daily fears of isolation, poor health, decrease in income, and loss of friends can contribute to an ailing health. In reality, caring for the elderly requires a community—nurses, doctors, family, friends—in order to maximize independence and decrease current challenges.
Rehabilitation can allow patients to regain communication skills, increase mobility and strength training, and gain emotional support. Rehabilitation programs offer patients and families the chance to learn, intervene, and reduce complications. These instructions are proactive in nature to prevent further accidents, injury, and acute hospital care. MN
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