Reducing functional decline of older people in an acute-care setting: are we providing adequate care to maintain/optimise the functional status of our elder patients?

AIMS: To improve practice in the care of the older person to ensure their functional status has not declined at the point of discharge by: determining available standards of care in relation to assessment of functional ability in the elderly; measuring current practice against standards of care based on the best available evidence; establishing priority areas for practice/improvement; implementing the practice/improvement plan; measuring practice to determine improvement in the management of functional decline in older patients and identifying further areas for investigation. METHODS: A multidisciplinary team used a range of knowledge translation tools and strategies in order to reduce functional decline of the older person in the acute-care setting. Audit was used to determine compliance with best practice standards and to determine the level of functional decline. A novel intervention was introduced in the form of a communal dining room and this was evaluated by the project team. The project was part of a program of seven projects (The Older Person and Improving Care) facilitated by a team with expertise in knowledge translation. Facilitation was provided though a structured education program and ongoing support. RESULTS: It was identified for this organisation that it was necessary to develop specific standards of care for the elderly in relation to functional decline. It was confirmed that there were unacceptable levels of functional decline in the elderly particularly in relation to mobility. The project team were able to show the feasibility and potential benefits of a communal dining room in reducing functional decline. CONCLUSIONS: It has been recognised that practice improvement activities are complex and that despite good planning and facilitation things do not always go to plan. This stated, it should be recognised that a great deal was achieved. Standards of care were able to be developed from an evidence base. These standards were used to develop an audit tool that confirmed deficits in practice. The outcome was a trial of a new intervention, a communal dining room, which showed considerable potential in reducing functional decline in the elderly.