Functional and Mental Status Outcomes: of Clients Discharged from Acute Gerontological Versus Medical/Surgical Units

Abstract

The goal of a specialized geriatric unit in an acute care hospital setting is to minimize losses and have the patient maintain or achieve an optimal level of functioning and cognition. This study showed that more acute clients on a geriatric unit maintained or improved functioning capacity at a significant level in fewer days and at a lowered cost. Nursing implications include inservice training specific to caring for geriatric clients and providing early assessment and identification of strengths. Interventions such as reality orientation and early proactive measures can be used to maintain or achieve optimal cognitive functional capacity.

A Medical Unit for the Acute Care of the Elderly

“…Preliminary Experiences Although acute care geriatric units differ in their patient‐mix, targeting, and physical characteristics (Table 1), they have some common threads 11–16 . These units create a physical environment that fosters independent patient functioning, and they emphasize an expanded role for primary nurses, multidisciplinary collaboration, comprehensive discharge planning, and the creation of a therapeutic milieu that recognizes that “the hospitalization, not the illness, may be the deciding factor in the functional ability of the frail elderly at discharge.” 14 On some of the units, geriatric teams provide consults to the primary caregivers, 15 while on others the geriatric team provides direct patient care 12 .…”

“…In these units, the primary nurse's role is expanded to include a targeted assessment of the patient's functional status, sensory deficits, risk of falls, and cognitive deficits 17 . The nurses are usually chosen to work on the acute unit, and the nurse staffing ratios are increased 12, 16, 17 . In one study, unit nurses could determine the need for activity, diet, and rehabilitation 14 .…”

“…Prompt nursing assessment facilitated early initiation of physical therapy and occupational therapy and encouraged patients to function independently 14 . The expanded role of primary nurses, through interventions such as reality orientation and proactive measures early in hospitalization, can effectively maintain or achieve optimal physical and cognitive functioning of patients 16 . In some studies, the primary nurse and/or gerontologic nurse coordinator play instrumental roles in the coordination of the interdisciplinary team.…”

“…Interdisciplinary discharge planning offers the hope of reducing the rate of rehospitalization or delaying the time between discharge and readmission 22, 23 . The interdisciplinary team may enhance the therapeutic milieu by including the patients and families in both the team conferences and the caregiving process 12, 14, 16 …”

“…The nurses are usually chosen to work on the acute unit, and the nurse staffing ratios are increased. ": 16,17 In one study, unit nurses could determine the need for activity, diet, and rehabilitation." Prompt nursing assessment facilitated early initiation of physical therapy and occupational therapy and encouraged patients to function independently."…”