Home care is best care
Hospital environments are designed to treat our patients during the acute phase of their illness or injury. The needs of the patients in the ward are different at different times of the day. The noisy and busy environment as a result means that patients get less rest during their stay. This can also result in confusion and disorientation especially when patients are elderly.
We all know how important rest is for recovery from an illness. Hence the importance of avoiding unnecessary admission to hospital or early discharge from hospital when starting to show improvement and where acute care can continue to be provided at home.
Being admitted to hospital unnecessarily or staying longer than necessary can have a negative impact on how well patients recover and can often cause serious harm, impacting adversely on their health and wellbeing. The benefits of being in the hospital must outweigh the risks.
It is important that we work together to ensure the decision to admit or that continue to stay in the hospital everyday is the result of a shared decision-making process. This means that you as a patient, family members and or other care givers make an informed decision after considering the benefits, risks and personal goals and expectations.
Ensuring that patients are given the chance to continue their lives at home is vital for their long-term wellbeing. We want to empower patients and their families with the confidence to continue their recovery in a familiar environment.
Please speak to your doctor or other clinical team member managing your care on admission and every day whilst in the hospital.
Why not hospital?
If you stay in bed for long periods, you lose mobility, fitness and muscle strength, which makes it harder for you to regain your independence. This is known as deconditioning. It is a decline in function and for older people with frailty, this may start within hours of their lying on a trolley or bed.
This results in a large proportion of patients:
- Experiencing delayed discharge
- Developing disability in activities of daily livings and hence dependency on others.
- Developing dependency on walking aids.
- Loss of bladder or bowel continence
Getting up, dressed and moving helps maintain muscle strength and your ability to do things for yourself. When you’re at home, just doing ordinary day-to-day activities helps to maintain muscle strength, even things like getting up to make a cup of tea. In contrast, when you’re in an unfamiliar environment like a clinical ward, you may be more likely to fall because you don’t have those familiar things around you to steady you if you lose your balance for a moment.
Find out more about deconditioning and how to prevent it here.
Good sleep is essential for a long and healthy life but it’s even more important when you're recovering from an injury or illness. Hospitals are busy places with lights, talking and noises from equipment, which can cause sleep deprivation. There’s no bed like your own bed when it comes to getting a good night’s rest.
Being in familiar surroundings with support from your loved ones is one of the best things for mental wellbeing. Hospitals are unfamiliar and can be very confusing which increases your risk of developing delirium (sudden confusion). When you are in hospital for a longer period, you may also lose confidence in your own ability to manage your day-to-day needs. With the right support, many people can return to living their life the way that they want to.
When you're unwell you're often less resistant to infections. We do everything we can to prevent you from developing an infection but the risk is usually lower at home where there are fewer unwell people under one roof.
Although there are robust measures in place to prevent infections in the hospital there is always risk of acquiring infections in the hospital. Data suggests that again our elderly are more prone than others to infections in the hospital.
Following admission there is an increase in the risk of developing hospital associated thrombosis (Blood clots in the deep veins of the legs). There are prevention measures in place to avoid Thrombosis, however our data suggests increased differential risk especially in our elderly patients.
If not hospital, where?
Working Together
We will discuss with you about what is important to you. We will do our best to answer any questions or worries you may have and work with you to achieve your goals.
Often the best place for your care and recovery is your own home.
We will talk together about your options. We want to make sure that, if you do not need to admitted to hospital that the right care is in place to support you to get better.
Where appropriate, and with your consent, we will involve your family or carers in making decisions about your health and care. You might find it helpful to include them in our discussions.
Checklist
Once you have had the care that you need in hospital, research shows that going home will help you get better much faster. If you need it, we will provide extra help for you at home or close by, to make sure you’re continuing to get better.
By asking questions, sharing information and following the advice of the doctors and nurses looking after you, we can help you get ready to go home quicker.
Before you leave hospital
Do you know where you are going (to home, to interim care, to a community hospital)
Do you have your own transport?
Do you have your medication and do you understand when to take it?
Do you have the equipment you need to go home?
At the home
Is the heating on?
Are the lights on?
Is there basic food in the fridge?
Concerns
If you are unwell and need medical help, please call 111 or visit 111.nhs.uk
If you are unsure about your medication, please call 111 and ask at the Pharmacy
Deconditioning
Half of admitted frail older patients experience functional decline between admission and discharge, and up to 50% of older people can become incontinent within 48 hours of admission. In the first seven days of admission, inpatients have reduced muscle strength by up to 10%, reduced circulation by up to 25% and reduced dignity, quality, confidence, independence, and choice.
Reference
https://www.england.nhs.uk/blog/recondition-the-nation
Thrombosis
The incidence rate of VTE increases exponentially with age. Thus, the elderly are at a much higher risk than the general population, and the risk is even higher among hospitalized elderly patients. The incidence increase from 1 per 10, 000 in young adults to 1 per 100 in the elderly.
Reference
Infections
The risk of contracting healthcare-associated infections (HAIs) increases linearly with increasing age. More specifically, HAI prevalence is 11.5% in patients aged over 85 years.
Reference
Cairns S., Reilly J., Stewart S., Tolson D., Godwin J., Knight P. The Prevalence of Health Care–Associated Infection in Older People in Acute Care Hospitals. Infect. Control. Hosp. Epidemiol. 2011; 32:763–767. doi: 10.1086/660871.
Delirium
The frequency among older hospitalized patients of delirium is up to 30% with higher rates among patients with frailty, hip fractures, advanced cancer.
Reference
Siddiqi N, Stockdale R, Britton AM, Holmes J. Interventions for preventing delirium in hospitalised patients. Cochrane Database Syst Rev. 2007 Apr 18;(2):CD005563. doi: 10.1002/14651858.CD005563.pub2. Update in: Cochrane Database Syst Rev. 2016;3:CD005563. PMID: 17443600.