Abstract
BackgroundWith ageing global populations, hospitals need to adapt to ensure high quality hospital care for older inpatients. Age friendly hospitals (AFH) aim to establish systems and evidence-based practices which support high quality care for older people, but many of these practices remain poorly implemented. This study aimed to understand barriers and enablers to implementing AFH from the perspective of key stakeholders working within an Australian academic health system.MethodsIn this interpretive phenomenenological study, open-ended interviews were conducted with experienced clinicians, managers, academics and consumer representatives who had peer-recognised interest in improving care of older people in hospital. Initial coding was guided by the Promoting Action on Research Implementation in Health Services (PARIHS) framework. Coding and charting was cross checked by three researchers, and themes validated by an expert reference group. Reporting was guided by COREQ guidelines.ResultsTwenty interviews were completed (8 clinicians, 7 academics, 4 clinical managers, 1 consumer representative). Key elements of AFH were that older people and their families are recognized and valued in care; skilled compassionate staff work in effective teams; and care models and environments support older people across the system. Valuing care of older people underpinned three other key enablers: empowering local leadership, investing in implementation and monitoring, and training and supporting a skilled workforce.ConclusionsProgress towards AFH will require collaborative action from health system managers, clinicians, consumer representatives, policy makers and academic organisations, and reframing the value of caring for older people in hospital.
Highlights
Longer life expectancy and expectations of “baby boomer” consumers bring challenges for modern health systems as they adapt to the changing face of patient care
The principles developed in these models must be expanded beyond small specialist units to all acute care settings caring for older adults to realise the benefits for patients and the healthcare system [4,5,6]. This challenge has led to the concept of the Age Friendly Hospital (AFH), and several authors have proposed supporting frameworks and practices [7,8,9,10,11] (Table 1)
Common principles espoused by these frameworks include senior organisational leadership that addresses institutional ageism; a system that respects older patients’ choices about care and care delivery; staff equipped with geriatric knowledge and skills; evidencebased practices (EBP) to reduce hospital-associated complications such as delirium and falls; a well-designed physical environment to promote function; and improved connections to promote smooth transitions across care settings (Table 1)
Summary
Longer life expectancy and expectations of “baby boomer” consumers bring challenges for modern health systems as they adapt to the changing face of patient care. The principles developed in these models must be expanded beyond small specialist units to all acute care settings caring for older adults to realise the benefits for patients and the healthcare system [4,5,6]. This challenge has led to the concept of the Age Friendly Hospital (AFH), and several authors have proposed supporting frameworks and practices [7,8,9,10,11] (Table 1). This study aimed to understand barriers and enablers to implementing AFH from the perspective of key stakeholders working within an Australian academic health system
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