Transfers to hospital for assessment and treatment of a change in condition have become customary. However, harms can outweigh benefit and may result in increased morbidity. In one Canadian study, approximately half of hospitalizations were considered avoidable. Transfer often results in long periods in an unfamiliar and stressful environment for the older person. Other hazards include delirium, hospital-acquired infections, medication side effects, lack of sleep, and rapid loss of muscle strength while bedridden. Frail older persons assessed and treated in their current settings have the opportunity to receive more individualized care and better comfort and end-of-life care. If a transfer is unavoidable, a person-centred collaborative approach is necessary to communicate the older person’s functionality and plan of care to ensure their needs are met. Much consideration should be given to the older person’s goals of care, including integrating a palliative approach to care.
Sources:
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