More complications and greater need for care for older patients
Older patients represent a large share of the hospital population and their numbers will continue to grow as a result of an ageing population. Up to half of older patients suffer complications during a hospital stay. Patients are also frequently discharged from hospital with worsening cognitive or functional complaints.
Belgium adopted a consultative geriatric care model in 2007. Dr. Mieke Deschodt, a leading researcher for the G-COACH project commented as follows: "Although this model definitely has positive effects, research has shown that the system has two major drawbacks, i.e. the advice from geriatric consultation teams is often ignored and the system does not focus enough on prevention. Interventions are only made after complications have manifested themselves. To develop the co-management care model in the G-COACH project we asked ourselves how we could adopt a more proactive approach to prevent complications, based on inter-discipline collaboration between the geriatric and cardiology teams."
Systematically charting care requirements
During the initial G-COACH phase we identified patients' care requirements and the care context for care providers within the various participating departments. This information was used in the development of a practice based co-management model for older cardiology patients. Care providers involved in the project were given the opportunity to provide input to the development of the geriatric co-management care model, to ensure that it was feasible and adequately supported.
Bastiaan Van Grootven, Project Manager for G-COACH: "A nurse of the geriatric support team at UZ Leuven is present every day at the bleeding & cardiovascular, heart & cardiovascular and heart transplant units to evaluate older patients at risk of functional decline on the basis of an extensive geriatric assessment. A comprehensive care plan is developed on the basis of this assessment and is then implemented by all care providers involved in the cardiology and geriatric support team."
Care model with major impact
The impact of the care model was measured for 454 patients aged 75 or older, who were admitted with an acute cardiovascular disorder.
The results are extremely positive. ‘Co-management’ of older patients results in less functional decline, fewer deaths and the number of complications is halved. The care model also had a positive impact on the quality of care: communication and inter-discipline collaboration between care providers improved, fewer bladder catheters were needed, fewer patients had to be restrained and the number of referrals to the fall prevention and memory clinic increased.
Expansion to other departments
Because of the excellent results researchers are able to state with confidence that the co-management model is particularly valuable in departments with a large number of older patients. The G-COACH team is consequently developing an implementation plan to expand this successful programme and introduce it in other departments and hospitals.