No abstract

Functional decline is a common complication for hospitalized older adults. Illuminating the factors that influence the physical function of hospitalized older adults is critical in order to develop effective interventions to prevent avoidable loss of function. Twenty-four older adults in three senior centres located in metropolitan New York City, who had recent experience with hospitalization, participated in focus groups to discover these factors. An exploratory qualitative design was used. Participants defined physical function as the ability to be mobile and resume the enactment of their roles, routines and relationships. Participants also believed that hospitalization should improve physical function. They described staff and system supports of, as well as the challenges to physical function in the hospital setting. The findings provide evidence for developing education programmes as well as new models of nursing care aimed at preventing functional decline.

Purpose -The purpose of this mixed methods study is to define the core components of a system-wide, acute care program designed to meet the needs of older adults. Design/methodology/approach -Concept mapping methodology (multidimensional scaling and cluster analysis) was used to obtain data describing the core components of a geriatric acute care model. The input of 306 "stakeholders" (clinicians, administrators, consumers, educators, and researchers) was obtained through a world wide web interface, supplemented with consumer interviews. Findings -The findings yielded eight clusters describing components of a geriatric acute care program: guiding principles, leadership, organizational structures, physical environment, patient-and family-centered approaches, aging-sensitive practices, geriatric staff competence, and interdisciplinary resources and processes. A total of 113 items that describe dimensions of quality were identified with these clusters. Practical implications -The clusters and dimensions provide a framework for a hospital to use to plan, implement, and evaluate an acute care model for older adults. Originality/value -There is not a common understanding of what constitutes a comprehensive set of resources, programs, and activities to address the needs of hospitalized older adults and their families and the staff who serve them. Concept mapping was an effective method of engaging the perspectives of various stakeholders in creating a framework to address these needs, as well as useful in illuminating areas for future research.

Function-focused care (FFC) is a rehabilitative philosophy of care with which nurses help patients engage in activities of daily living and physical activity with the goal of preventing avoidable functional decline. This prospective, observational study described the degree of FFC provided by nursing staff to Chinese American (n = 32) and non-Chinese American (n = 43) older adults in medical-surgical units of an urban hospital. In both groups, only a few ADLs were a focus of FFC. Loss of physical function occurred, and physical function did not return to baseline by discharge in both groups; however, FFC was associated with less decline. Results suggest that hospitalized elders, both Chinese American and non-Chinese American, can benefit from nurse-led FFC. FFC may help minimize functional decline and decrease the use of postacute care rehabilitation. The gerontological rehabilitation nurse can play an essential role, guiding a function-focused approach throughout the hospital stay, including with the transitional care plan.