Thursday, 1 October 2015

International Day of Older Persons

Robyn Gallagher
Editor, JAN

Older people are a rapidly increasing proportion of populations worldwide, yet health services have not responded to this challenge well, continuing to focus on acute care when multiple care avenues are needed. Several papers in JAN help nurses consider the care of the older person and offer hope that future research will address their needs.

The emergency department (ED) represents the front-line in care for many older people. This is because older people have more repeat ED visits and more frequent hospital admissions and re-admissions than their younger counterparts and these admissions occur primarily through the ED (Lowthian et al., 2013). Increasingly, ED presentations for older people are coming from nursing homes, not just because of the rise in residential aged care placements, but also because nursing home staff are facing increasing challenges in care provision. Laging and co-authors (Laging et al., 2015) report on a meta-synthesis of 17 qualitative studies that the factors that influence nursing home staff decisions are often resource-driven. Nursing home staff have limited capacity within their team or in the form of medical advice to provide interventions that could prevent the need for ED transfer. As a result nurses are likely to opt for automatic transfer for diverse and often non urgent health problems. On the other hand, many ED presentations for older people occur in a pattern of readmissions (Gallagher et al., 2014) indicating that hospital discharge processes may not have been adequate. Readiness for hospital discharge measures may not appropriately address older people, and modifications for older people to measures is recommended in Mabire et al., 2015. The results of their research indicate that incorporating scaling for living alone, older age and the patient not feeling ready for discharge is important when using the Readiness for Hospital Discharge Scale in older people.

Two areas that result in ED presentations and the need for urgent care for older people are falls and elder abuse and neglect. Two papers included in JAN this month flag promising interventions. Loh and co-authors (Loh et al., 2015) published a protocol to help nurses detect and manage elder abuse, a common and well-hidden problem. In another promising intervention, Francis-Coad and her team (Francis-Coad et al., 2015) are testing a community of practice to help reduce falls in residential aged-care. In this proposed community of practice the partners are academics and aged-care staff across a very wide geographic area in Western Australia.

These four papers bring together past, present and future for supporting older people.


Francis-Coad, J., Etherton-Beer C., Bulsara C., Nobre D. & Hill A.M. (2015) Investigating the impact of a falls prevention community of practice in a residential aged-care setting: a mixed methods study protocol. Journal of Advanced Nursing.

Gallagher, R., Fry, M., Chenoweth, L., Gallagher, P. and Stein-Parbury, J. (2014) Emergency department nurses' perceptions and experiences of providing care for older people. Nurs Health Sci. Vol 16(4):449-53.

Lowthian, J., Curtis, A., Stoelwinder, J., Mcneil, J. and Cameron, P. (2013) Emergency demand and repeat attendances by older patients. Intern Med J. Vol 43(5):554-60.

Laging B., Ford R., Bauer M. & Nay R., (2015) A meta-synthesis of factors influencing nursing home staff decisions to transfer residents to hospital. Journal of Advanced Nursing.

Loh D.A., Choo W.Y., Hairi N.N., Othman S., Hairi F.M., Mydin F., Jaafar S.N.I., Tan M.P., Ali Z.M., Aziz Z.A., Ramli R., Mohamad R., Mohammad Z.L., Hassan N., Brownell P. & Bulgiba, A. (2015) A cluster randomized trial on improving nurses’ detection and management of elder abuse and neglect (I-NEED): study protocol. Journal of Advanced Nursing

Mabire C., Coffey A. & Weiss M. (2015) Readiness for Hospital Discharge Scale for older people: psychometric testing and short form development with a three country sample. Journal of Advanced Nursing

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