Chapter 17: Care of the Frail Older Adult

Peter is 80 years old and is frail; walking with an aid, he can move from room to room but cannot leave his home without help. He needs support with all activities of living. He lives in his own home, which has been adapted for his needs. His son lives a few streets away with his wife and one daughter who is still living at home. These three are Peter’s only family support but he has a package of care, which provides four visits a day from caregivers who help him with personal care and make his meals. Recently he developed a chest infection and refused to go into hospital as his GP had arranged. His son tried to persuade his father to be admitted to hospital, as he was concerned about him at home. Peter would not agree and the family began taking turns staying in his home him.

Question

  • What alternatives could have been offered to Peter and his family?

Answers

  • Peter may have been admitted into a general medical ward or ward for older people and these may not have met his needs. An alternative would have been a ward for people who are frail that would have been designed for his needs. These are increasingly being developed across the country.
  • He may have had previous negative experiences of hospital and this could have been addressed by exploring his concerns.
  • Peter may simply wish to stay at home and across the country there are hospital at home services where the health team can come to Peter’s home and work with his family and carers.
  • Peter may be afraid that he will deteriorate in hospital leading to a move to care home or that he may die. Careful conversations with Peter could identify what his wishes could be and how they might be met. An anticipatory care plan would have been a helpful tool in this discussion.