In 2010, 38.7% of all people discharged from short-stay hospitals were age 65 or older (National Center for Health Statistics, 2010). The traditional acute care model focuses on the treatment and diagnosis of disease. The resulting environmental design reflects the needs of clinicians to efficiently utilize appropriate medical technologies, equipment, and protocols. However, many older adults present to acute care settings with a number of chronic conditions and functional limitations, in addition to their acute symptoms (Parke, 2007).
Hospitalized older adults frequently experience a decline in functional abilities upon discharge.
The acute care setting is often insufficiently organized to provide the kind of comprehensive, supportive care older adults need. Consequently, hospitalized older adults frequently experience a decline in functional abilities upon discharge. Falls, hospital-acquired delirium, and loss of independence all contribute to poor outcomes among older adults.
Several acute care risks and potential design strategies are highlighted in the table below.
Many of the design strategies recommended to support older adults in the residential care environment are also appropriate in acute care settings. Focused attention on quality lighting, noise reduction, simple wayfinding, appropriate furnishings, and well-chosen finishes are design strategies that can also improve acute care environments for older adults.
Focused attention on quality lighting, noise reduction, simple wayfinding, appropriate furnishings, and well-chosen finishes are design strategies found in residential care environments that can also improve acute care environments for older adults.
Acute care settings that successfully support the needs of older adults frequently employ additional staff with specialized training in geriatrics. Some emergency departments provide separate triage and treatment areas for older adults that decrease environmental stress typically experienced during an emergency visit.
Brandis, S. (1999). A collaborative occupational therapy and nursing approach to falls prevention in hospital inpatients. Journal of Quality in Clinical Practice, 19(4), 215-221.
Collier, R. (2012). Hospital-acquired delirium hits hard. Canadian Medical Association Journal, 184(1), 23-24.
Gabel, L. (2012). Designs to support aging acute care patients. Health Facilities Management. Retrieved from: http://www.hfmmagazine.com/display/HFMnewsarticle.dhtmldcrPath=/templatedata/HF_Common/NewsArticle/data/HFM/Magazine/2012/Apr/0412HFM_FEA_interiors
Hitcho, E., Krauss, M., Birge, S., Dunagan, W., Fischer, I., Johnson, S., . . . Fraser, V. (2004). Characteristics and circumstances of falls in a hospital setting: A prospective analysis. Journal of General Internal Medicine, 19(7), 732-739.
National Center for Health Statistics. (2010). National Hospital Discharge Survey. Retrieved from http://www.cdc.gov/nchs/nhds_tables.htm
Parke, B. (2007). Physical design dimension of an elder friendly hospital: An evidence-based practice review undertaken for the Vancouver Island Health Authority. Vancouver, BC: University of Victoria, Centre on Aging.
Tan, K., Austin, B., Shaughnassy, M., Higgins, C., McDonald, M., Mulkerrin, E., & O’Keeffe, S. T. (2005). Falls in an acute hospital and their relationship to restraint use. Irish Journal of Medical Science, 174(3), 28-31.
Ulrich, R., Zimring, C., Zhu, X., DuBose, J., Seo, H., Choi, Y., . . . Joseph, A. (2008). A review of the research literature on evidence-based healthcare design (Part 1). Health Environments Research and Design Journal, 1(3), 61-126.