By Victoria Hurley-Schubert, Staff Writer
Victoria Hurley-SchubertStaff Writer
Unique spaces designed with elderly patients in mind have been created at the new University Medical Center of Princeton at Plainsboro.
Older patients will have extra special care with an Acute Care for the Elderly Unit (ACE) and a geriatric emergency room. Older patients have very different needs than younger ones and these patients often have better outcomes when they are catered to with designated areas and specially trained personnel.
”This is a model of care that was developed about 20 years ago,” said Susan Lorenz, chief nursing officer and vice president of patient care. “When older people get sick and go into the hospital they have higher incidents of adverse outcomes and end up not being able to transition back home and end up going to nursing homes. They lose a lot of functional ability just from being in the hospital. Having identified that we realized that they have different needs; you can’t take care of a 40-year-old the same way you take care of an 80-year-old. It doesn’t work that way.”
Elderly patients do not have the functional abilities or reserves of younger patients and do not recover as well.
”It’s all those aging things that are age-related,” said Ms. Lorenz. “These patients need to be monitored in a different way.”
Generally, patients more than 65 years old are eligible to stay in this specialty unit.
Focusing on caring for the whole patient, the ACE unit staff will meet as an interdisciplinary team to discuss each patient overall and monitor all aspects of their care and develop individualized plans of care. Team members include a geriatrician, a geriatric trained pharmacist, a geriatric trained dietician, case managers, social workers, patient nurses and the geriatric coordinator.
”We really look at what are things we can do to get the patient back to their prior living arrangement safely,” said Daphne Berei, nurse manager of the ACE unit. “We want to make sure testing if appropriate is timely and we are planning for a safe discharge as soon as possible.”
The single-patient rooms in the unit were designed with older patients in mind and increased safety.
To prevent falls, a nightlight was installed between the bed and bathroom in all rooms. The path to the bathroom is guided by grab bars.
The bathroom doors, not just in this unit but throughout the hospital, were designed as sliding barn door style to prevent the door from knocking into patients and staff. The frosted glass of the bathroom door provides privacy, but adds additional soft light at night to help patients feel comfortable.
”(The elderly) get in-hospital dementia because they’re in unfamiliar surroundings,” said Ms. Lorenz. “At night the sun goes down and they get a little confused and don’t know where they are. It happens to people that are alert. It’s just part of being in an unfamiliar environment.”
To avoid the temporary delirium, family members are encouraged to bring pictures from home, said Ms. Berei.
Widows in each treatment room in the geriatric section of the emergency room help keep seniors in tune with what time of the day it is and the ACE unit is keenly aware of this issue, providing assistance to keep patients’ internal clocks correct. Measures include quiet time, minimal disruptions and adjusting medication schedules to minimize nighttime intrusions when possible.
”The elderly patients can very commonly confuse day and night so we have put some unit guidelines in place to help enhance sleep habits,” said Ms. Berei. “Ten o’clock every night is quiet time so TVs are off, lights are dimmed and the noise level is reduced and we take our last set of vital signs at 10 o’clock. We won’t wake the patient to take vital signs in the middle of the night unless their condition warrants it and their physician orders vital signs during the night.”
All off the staff in the unit are geriatric resource trained and many are certified in geriatric nursing to understand the unique needs of the elderly.
Some of the unique needs of this demographic are managing multiple medications and possible interactions. Medications are all reviewed by an in-hospital pharmacist to eliminate this risk.
The ACE unit also has a small workout room for the patients to get some exercise.
What would have been a family respite room was repurposed into a community room where patients are encouraged to eat together and socialize with some structured activities to keep them stimulated with conversation and interaction with others, said Ms. Lorenz.
Senior patients who dine together tend to eat more in a social environment, said Ms. Berei. Families will also be encouraged to join their ill family member in the ACE unit with root beer float socials on Monday evenings, not only for socialization, but to increase calorie and fluid intake in the elderly.
”The other thing elderly people have a problem with is isolation. They are here by themselves. They like to socialize and be with other people,” said Ms. Lorenz. “This way this allows for communal dining and playing bingo or whatever. Staying in the room is the worst thing for anybody really, but an older person in particular.”
Activities include pet therapy, art therapy provided through the Arts Council of Princeton on Fridays and music therapy with a strolling harpist on Wednesdays and a guitarist from a local high school on Sundays.
To encourage the elderly to socialize, the patient chairs have been replaced with a reclining chair that is on wheels to allow the patient to exit their room.
”This is a very comfortable recliner where the seats go up and its got an IV pole attached to it and an oxygen tank attached to it,” said Ms. Berei. “The idea is all of patients are strongly encouraged to get out of bed every day so this chair will provide a comfortable place to sit with easy mobility to activities.”
The ACE unit is based on nationally developed standards from the Hartford Institute for Geriatric Nursing New York University College of Nursing that were adopted by the University Medical Center at Princeton in 2007.
