Specialized approach to senior care

The specialized approach to senior care (AAPA) developed by the /typo3conf/l10n/fr/rtehtmlarea/Resources/Private/Language/fr.locallang_accessibilityicons.xlf:external_link_new_window_altText Ministère de la Santé et des Services sociaux (MSSS) adapts how services are organized and how care is delivered to seniors who are hospitalized or who come to the emergency room. The goal of the AAPA is to do everything possible to prevent and, if possible, avoid physical deterioration in elderly patients.

This approach reorients care and services to account for seniors’ specific needs and characteristics. The physical environment is adapted to seniors, while staff focus their care relationship on the senior patient. This approach also encourages seniors to get involved in their daily activities to maintain their mobility. This change in focus is necessary to adapt to the aging of the population.

The aging of the population is a clear reality:  

  • Like the Quebec average, nearly 7% of the Laval population is made up of people aged 75 and over.
  • In the emergency room, just over one third of patients on stretchers are 75 and over.
  • On average, more than 50% of hospital beds are occupied by people aged 75 and over.
  • About 45% of all hospitalization days in Quebec are spent by people aged 65 and over, even though this age group represents only 14% of the population.
  • Since 1987, the number of hospitalizations of people aged 75 and over has doubled.
  • The percentage of people aged 65 and over in Quebec will almost double in the next 25 years, and will rise 14% to over 25%.

As the CISSS de Laval cares about the quality of its services and its response to people’s needs, it has chosen to take action and has implemented the specialized approach to senior care (AAPA) at the Hôpital de la Cité-de-la-Santé. 

Overall, the AAPA includes different care approaches that are specifically adapted to seniors who go to the emergency room or who are hospitalized. These approaches are in line with the six main areas for monitoring and assessing  seniors at the hospital.

Functional independence:

  • Keep the person active and moving    

Skin integrity:

  • Maintain the person’s skin health    

Nutrition and hydration:

  • Make sure the person eats and stays hydrated    

Toileting:

  • Make sure the person goes to the bathroom regularly      

Cognitive status:

  • Help the person stay alert and avoid confusion    

Sleep:

  • Create an environment that is conducive to sleep     

These areas are evaluated by health care staff throughout the person’s hospital stay to make sure seniors do not decline in function and can return home as quickly as possible.

Démarre le chargement du fichier To learn more, consult the information sheet “Ici, on s’adapte à vous” (Our goal is to adapt to you). (In French only)

A mobility and walking program was launched to help users increase their mobility. It has been scientifically proven that when seniors stay as active and mobile as possible, they avoid many complications, such as physical deterioration and losses of independence. This program encourages seniors to get moving in their daily activities throughout their hospital stay, either by themselves or with the help of loved ones. The program also gets staff to stimulate and encourage these patients and to get them and their families involved in mobility activities.

The mobility and walking program is also for seniors who had problems with mobility and walking before they came to the hospital and who develop mobility problems during their hospital stay, for example, due to a complication from a disease. In these cases, staff and the patient’s doctor will choose solutions and provide specific care to avoid or reduce the risk of physical deterioration and losses of independence. The goal is to keep seniors as independent as possible during their hospital stay.

  • Because, for people aged 75 and over, just one day in bed results in three days of hospitalization. For every ten days in bed, the recovery period can take up to 4 months for these clients.
  • Because a hospital stay is one of the major causes of losses of independence in seniors, especially if bed rest has been recommended while the person is in hospital.
  • Because it has been estimated that inactivity from bed rest reduces muscle strength by 5% a day in seniors, compared to 1.5% a day in young adults.
  • Because staying in bed leads to bone demineralization, which occurs 50% faster in seniors than it does in young adults.
  • Unless not recommended by the person's doctor or care team, all seniors should stay mobile when in hospital.
  • Simply getting up, eating a meal in an easy chair, or going for a walk are all good ways to get moving!

Démarre le chargement du fichier To learn more, read this fact sheet on functional independence. (In French only)

A prevention, evaluation and monitoring protocol has been set up to prevent delirium, particularly in seniors. Delirium is a disrupted state of mind that affects cognitive abilities (memory, orientation, perception, thoughts, etc.) and state of consciousness (awareness).

Delirium is a state of confusion that develops quickly but that doesn’t last if treated. People may say strange things, have hallucinations, become disoriented, no longer recognize their relatives, or show unusual behaviour. This acute organic (or physical) syndrome can be caused by several factors and can occur at any age. However, it is particularly common among seniors.

 Démarre le chargement du fichierTo learn more, read this fact sheet on delirium

Delirium affects 10% to 65% of hospitalized seniors and 15% to 70% of people living at residential and long-term care centres. Delirium is one of the main causes of functional decline in hospitalized patients and people in residential care.

Scientific studies show that a suitable environment can help compensate for any problems or disabilities that seniors have while reducing the risk of factors related to delirium and immobility , the two most common geriatric syndromes that lead to functional decline. Making changes to the person’s environment helps reduce functional decline in seniors. Here are just a few of the many examples of changes that can be made:

  • A height-adjustable bedside table or easy chair will make the person more comfortable and independent, regardless of their age or height.
  • Keeping hallways clear of clutter helps people get around easily and helps decrease functional decline.
  • Reducing noise at night promotes sleep for all users.

The CISSS de Laval is sensitive to these needs and is actively working to improve the physical environment at Hôpital de la Cité-de-la-Santé to meet the recommendations for seniors.

Démarre le chargement du fichierTo learn more, read the guide to setting up the physical environment and equipment. (In French only)

The AAPA is an organizational priority for the CISSS de Laval. Clinical follow-up committees and a medical follow-up committee have been created to ensure that the AAPA is applied throughout the hospital.

Teams in these specific care units are supported by a specialized geriatric nurse who helps them incorporate these new practices in their daily work.

For more information, talk to the patient’s care team or doctor.