If we divide the outcome of diseases into ...two categories ..

1) if the outcome of disease is positive and life will be longer (age of patients is within the range of age of birth for respective country,,.. means if in developing countries 'age at birth' is 65 to 70 years and so if patients is below 70 or 75 years old with abnormalities of disease which can be cured...then the 'different ward in Hospital" is necessary provided that relatives should be with him for 24*7 hours  ...while on other hand...

2) if patients age is more than 75 years age and affected with deadly disease whose outcome will not be positive ...in such cases we do not have any right to take is happiness (being at home with his beloved) away from him ...for these cases which do not have positive outcome there is no need of special ward ..But again this varies depending upon the patients to patients ...

eventually there is need of special ward for elderly but at the same time it should not be "old age home" for them where every younger can leave there parents for die....

Perhaps instead of segregating the elderly; specialised wards for any person who requires additional help should be provided. There are plenty of people who are not elderly who are not self sufficient, just as there are many elderly persons who are self sufficient. I do worry that more and more we separate the elderly from our communities leading to an almost dehumanising effect...

A 90-years old man was at the hospital. He lived at home without any help and he managed his life well. When this man come to hospital with a simple disease, he was treated as a man without any self sufficient possibilities. It was an afoul experience for him. Nurses ware meet him as a helpless old man. Lot of other cases can be mined, were the age requires the kind of help the elderly needs. My opinion is, if we have a team of nurses how have the competence to assess the caring needs and provide care in line with them don´t need  different units for to provide good care. If we have differed  people from each other based on age, young people my not got the help they need, and older people got more help than they never need. The age is not self evident for caring needs.

Dear Colleagues,

Thank you for this thread.

We need to discuss these issues openly and, as experts, provide guidance for health care institutions, formal caregivers, informal caregivers, educators and researchers.

You present an interesting and important discussion, but PLEASE DO NOT USE THE TERM "ELDERLY". Most people who do aging research and who provide services stopped using this term 20 years ago.

Just say "older adults". Then if need be, we can contrast older adults with younger adults. In many societies, older adults already experience enough stigma and prejudice.

thanks

Dear colleages,

An interesting question is raised. I would like to elaborate on two above mentioned points:

1: "It is generally accepted that elderly people because of some conditions require more intensive management than can be provided..." ... Indeed I agree, to mention one example: developement of delirium can occur regularly.

2: "My opinion is, if we have a team (of nurses) how have the competence..." ... According to me, this is the key point. I have worked in a special geriatric hospital ward. In this seperate ward, the whole team was focused on care, love AND scientific medical knowledge about (older) geriatric patients. Their first choice and specialisation was to work with older patients.

Three examples of advantages:

- Prevention of delirium; implemented in the interior, architecture, early detection (by nurses using a delirium scale) and latest knowledge of how to treat it well. And the knowledge of the whole team about making the difference between dementia and delirium.

- Decision making (treat or not to treat): here comes the point that was made above by colleage Balu Mote. The extra experience on the ward (team of doctors and nurses together) with end of life decision making: knowing when to stop curative treatment and start palliative treatment.

- Implementation of the transfer-team in the geriatric team. With the knowledge of how to organise discharge planning: 'home care', 'transfer to nursing homes', 'geriatric rehabilitation', conversations with the family etcetera...

Dear Dr. Vitaliano,

Nice. I think the terms aren't important and our work for the people are essential.contrast older adults with younger adults is good. but do the elderly or old adults need an special ward in hospitals for a better care as the children have ? Or it is better to care them in a general ward with young patients or middle age patients?

Dear Dr. Aghakhani,

Thank you for your note.

I am not a clinician, but I am a professor in Psychiatry and Psychology, so I have experience with the technologies and clinical work done with older adults.

What I have learned is that in America we do some things that are innovative and we have contributed greatly to research and clinical work around the world.

However, Americans have often times thrown out or ignored common sense and tradition. For thousands of years, since the Neanderthals,  our ancestors have taken care of others in a family network. I believe that in Italy, families participate much more in caregiving when their relatives are in institutions than they do in the US. I am sure this is true in the Middle East, Asia, and much of the world.

Having children and older adults together has both benefits and challenges. I believe that research and clinical work has shown that when older adults interact with younger adults, they derive much pleasure. This is why so many programs have been developed to bring children into nursing homes and hospitals.

However, there are times when children may become fearful if they see others in pain or who are suffering. They may not understand the situation.

I am not an expert in this area, but I wanted to join the discussion because in the US aging is not revered as in Asian countries. I fear that as American culture has more and more influence on the world, even the Asian countries may become more like Americans.

Best wishes.

peter

Dear Dr. Vitaliano,

Thank you. I know that when older adults interact with younger adults, they derive much pleasure.

But, my mean is that, Because of diseases that effect on old adults, Do we need hospitalized them in a isolated ward without young or middle age patients?

Is it ethical that classified them?

dear Colleagues, the "core" of geriatrics is dealing with "multiple / simultaneous / interacting" problems, according to the "heuristic" paradygm by Kane: that, to me, could be translated also in hospital organization; more, one example of the special kind of competence & feeling requested to geriatricians may come from the alleged file just downloaded

best regards, Mauro Colombo

I share the conviction that a geriatric ward is specular – for opposite reasons - to pediatric ward. Older adults need a specific attention for the change – biological, psychological and social – that affects them and requires a multidimensional assessment in order to allow their adequate recovery and a proper release towards home. Besides, many of them have comorbidity and use polypharmacy, whose interaction must be well known by physicians. Last but not least, in many countries they account for the most relevant part of the public expenditure, which must be kept under control.

Segregating patients based on social characteristics , such as age , rather than specific disease entities does much more harm than good .In an early study we conducted on the practice of segregating elderly patients in mental hospitals ,we found that those random;y assigned to a ward of younger patients ( age integration ) did much better. Age segregation creates stigma and low expectations for recovery.

At this time of the thread … I think we have to go back to the point … Is the question about elderly people in a general hospital or in a specialized facility like a mental hospital? If, that is my opinion, we are speaking about a general hospital, then the appropriate words are efficiency and efficacy, nothing to do with segregation and stigma, but only with a quick recovery and a return home in the best shape possible.

I agree with my colleagues (above). This decision should be made based on the needs of the individual in care; this is what leads to well-being and as Dr. Kahana says,  

integrated care has empirical support.

Elderly care wards in acute hospitals are valuable for  a number of reasons; I do agree with Dr Kabboord. Expertise is often built up in staff working with older people, the physical environment can more easily be adapted for the needs of older people and conditions such as hypo-active delirium are more easily identified and less often overlooked. This means that elderly care wards can be made safer places which chimes in well with the Francis Report 2012. In psychiatric inpatient care, the services in the UK are configured such that the multiple physical co-morbidity, differing psychological and social needs and the safety of older patients  can most practically be offered in an older person's unit. It is in this setting that old age psychiatrists are most vocal about the need for "age appropriate services".

Jenkinson J and Warner J (2013) Whither old age psychiatry? Ageless psychiatry services in the UK – a worrying trend. The Lancet 381 9882, p1985 www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61202-7/fulltextal about the need for "age appropriate services".

It is not clear from the question whether the care referred is acute, intermediate or frail care. For acute care and intermediate care where the person will go home after a stay of up to 60 days then no, there are no grounds for segregation. For  frail care services then yes, it would be appropriate and of more benefit to the patient, although this type of care is not usually done in a hospital but in a specific frail care centre. Staff do become more specialised, their roles are more clearly defined and specialist gerontology services  ensure that medication and programme components are designed for the older person. The physical environment can be structured to suit the aging person and to encourage as much independence as possible, which might not be necessary in a facility with mixed age groups. Therapy and activities could be aimed at a specific level of age and experience, which would also be more meaningful for the older person and increase social interactions. This in turn would decrease the possibility of depression.

There are obviously negatives in that familiarity with patients in long term care can sometimes lead to signs of distress or onset of illness being misinterpreted and ignored. Abuse can occur in environments where the sameness of routine and long term staff input can cause burnout. Cost containment can lead to services being reduced to this group because of their perceived lower life expectancy. These are all considerations.   

I am glad Jo- Ann brought up the benefits of ACE units that offer tailored care for seniors in general hospitals and offer enhanced care for this group.Those pose a benefit. But I would distinguish those from any systematic segregation of older patients , as such policies are likely to yield more harm than good.

indeed my quotation by Kane [multiple / simultaneous / interactive] pertained to acute & intermediate care settings [rehabilitation included, as my everyday experience]; more - in Italy - home care services deal in vast majority with old people

best regards, Mauro Colombo

Dear Dr.McKenzie,

You wrote "It is extremely important that the care needs are carefully triaged and people are not placed on a unit purely relating to age."

OK. I agree, but  do the elderly need an special ward in hospitals as the children have for a better care?Because of their physiological and psychological condition that differs from the young people as children differ, too.

Part of the issue is that our acute hospital system (the one that the vast amount of healthcare $ is spent on) has become so specialised that it struggles to provide holistic care that frail and vulnerable older people need. There is good evidence around that identifies that older people who are frail and have multimorbidity benefit significantly from geriatric lead interdisciplinary models of care that focus on individual's physical and psycho-social needs, maintaining function and improving independence and involving family and carers in developing an individualised care plan. All concepts that are not likely in a rapid turn over acute care model of care. Of course the vast majority of older people are robust enough to be well managed in general hospital settings- the challenge is in identifying those that are not, the ones for which functional decline and geriatric syndromes require a comprehensive geriatric assessment and management which the evidence suggests is best provided in geriatric units. The following I found very helpful, especially in reviewing the case for in hospital care models: http://www.ncbi.nlm.nih.gov/pubmed/21968859

Given the risks of hospitalisation in this group, perhaps we should be much more open to models that provide specialist care for vulnerable older people out of hospital, such as in their homes, as the rule rather than the exception. Such a community based approach that is more likely to support integrated care  which is so important for older people.

I am still of the opinion that every person has to got the care he/she need. It´s not the age witch state if the person can got specialist care. I don´t think it will be possible to move over the specialist care to the patients home, but we need competes to take care of an older people eminently when he/she is so called clinical ready to move out from the acute ward, and we can thereby minimize the risk of hospitalization. In the future we need more competence to the teams of the home care. 

Dear Dr.Frilund,

You know there are some physiological and psychological changes between the young and the elderly as like as young people and children.

Always speaking about a geriatric ward for acute diseases in a general hospital and as described in some of the links kindly reported by some colleagues, it is important to avoid the immobilization syndrome. Also with providing architectural factors of prevention.

I remember that the syndrome starts as a result of the acute condition that has determined the admission (for example the pneumonia ) that interacts with pre-existing factors (cognitive impairment, diseases bone or joint, muscle wasting, decreased mobility with use of aids) and often with elements associated to hospital treatment (Hirsch , 1990; Ettinger, 1992; Vorhies, 1993).

Among the contributing factors closely associated with the interventions activated in the hospital, there are care and treatment procedures that reduce the possibility and the ability to move the patient, such as intravenous infusions, the bladder catheterization or monitoring systems and non-invasive and invasive physical restraint or medication.

As I said in the introduction, architectural factors can also contribute to the immobilization syndrome (e.g. lack in many departments of spaces dedicated to physical therapy, lack of safeguards to mobilize independent people as aids, the handrails in the corridors, hospital rooms designed thinking about "bed" and not about “the sick person”) and organizational (lack or shortage of rehabilitation therapists, but also nurses and auxiliaries as well as reduced times of ingress for family members or private caregivers that could collaborate in moving patients). In this context, it is also important to point out stereotypes of misbehavior extremely popular, and difficult to change. I refer particularly to the erroneous belief, of patients and their families, that bed rest is the first and essential remedy in the course of the disease.

As evidence indicates,  elderly do benefit of special wards (http://www.cochrane.org/CD006211/EPOC_comprehensive-geriatric-assessment-for-older-adults-admitted-to-hospital).  This usually includes some spacial adjustments but most important, an interdsciplinarty team.

A unit designed for taking care of seniors especially those with dementia is a great concept to put forward. We have specialized long term care units (Memory Care Units) where dementia residents are provided care, so, it is reasonable to have them in a specialized unit during acute care episodes. With the growing number of  seniors dementia-related diagnoses, a well-trained staff (much like a pediatric unit is trained to handle pediatric related care), is a great concept.

A rather surprising question . Why not ask  " Do children need special wards in hospitals the same as elderly ..." 

after voting up the "joking" answer by Arthur Leibovitz, I do agree with Ron Ordona; more, in next months, I hope to be able to post in ResearchGate a paper reporting the [+] results of our experience about the rehabilitation of persons with dementia having both hip fracture & Behavioural and Psychic Symptoms of Dementia, within the Special Care Unit at Golgi Geriatric Institute

best regards, Mauro Colombo

Dear all,

we know that physiological condition in children defers from young and physiological condition on elderly defers too.

For this reason, Do the elderly need an special ward in hospitals as the children need? Edit

Thanks Mauro, will be interesting to see research showing positive outcomes in a highly vulnerable group that there is little focus on but are a significant cohort in acute hospital work, especially orthopaedic.

Would like to reinforce Antonio's response and distinguish older people with complex care needs who are best managed in specialised units and the majority of older people admitted into hospital with an acute illness. While most will cope well some are at risk of experiencing functional decline. Acute care needs to get much better at identifying and responding to older people at risk of functional decline, generally as a direct result of the care models in acute; ie bed resting, fasting, focusing on a specific condition and not the whole person. I suspect that better care models and pathways for older people in acute  will go along way to reducing the need for specialist geriatric units except for the very frail and vulnerable.

Is it possible to make our hospitals 'older friendly'? More controversially, perhaps all older people should be managed in specialist geriatrics and  other specialists are referred in. Increasingly, acute hospital care is for older and frailer people as younger or fitter people tend to have most of their acute health needs managed in the community or in short stay units anyway.

(This is an article lifted from Philly.com): Kim Shields, a nurse, and Mary Hofmann, a doctor, like to think of Abington Memorial Hospital's new Older Adult Specialty Unit as "prehab."

The 21-bed unit, which opened in mid-June, is meant to prevent complications that often befall the elderly when they are hospitalized.

"What we're doing is promoting wellness in the midst of their illness," Shields, who is clinical director of the geriatric service line at Abington, said during a tour of the unit.

Too often, hospitals can cure an older woman's pneumonia, for example, but she goes home weaker and is never the same again.

"We don't want to hear that," said Hofmann, the hospital's chief of geriatric medicine.

While other hospitals have created special programs for their frailest elderly patients, Hofmann said Abington's approach is unusual. It focuses on people 70 and older who can still walk and are in pretty good mental shape, with the goal of keeping them that way.

So that they don't get weaker, more confused, or depressed, patients are expected to walk in the halls three times a day and will be strongly encouraged to participate in group recreational activities and meals. "The medical literature will say that there is almost no reason for bed rest," Hofmann explained.

To prevent falls, the physical design compensates for failing eyesight and spatial skills.

The floors are purposely less shiny because older people find glare disorienting. While most of the hospital is decorated in blues and greens, the palette in the new unit is from the yellow end of the spectrum. Older eyes see those colors better. Letters on signs are twice the usual size. Trim along the floor and door frames is dark gray to make boundaries easy to see.

The primary goal is to keep patients healthy and independent longer. And word-of-mouth from happy patients and families could attract more patients, Hofmann said.

just a quick note, thinking of the floors of the bathrooms aside the rooms in the rehab ward I lead: contrasting yellow and dark gray ... best regards, Mauro Colombo

There appear to be benefits from specially designed acute care units for older adults that hace been documented in the literature. However it is not at all clear that it is age segregation that provides benefits.It may be the motivated staff or geriatric knowhow portrayed in these special units that is helpful. Our early studies of age segregation in psychiatric hospitals ( patients were randomly assigned to age integrated or age segregated units) revealed that those older adults placed in age integrated units did better.

decades ago, when psychiatric hospitals were closed by the reform of the national health system, aged psychiatric patients were fruitfully hosted in our nursing home

happy new year, Mauro Colombo

Sure ederly need special manangment also so of them in respect them have more and more comorbid disease also has mental demintia

delirium deserves special attention

70 to 80 % of persons elder than 70 years have at least two up to 8 chronic disorders. These patients suffer from multimorbidity and even more than half of people with multimorbidity and nearly two thirds with physical-mental health comorbidity are younger than 65 years (Barnett et al. Lancet 2012). The question to be answered is about the competence of the treating persons (medical doctors, nurses, allied health professionals etc.) Does a specialist in a medical discipline have an overview about the diagnosis and therapy of all other disciplines and does the geriatric specialist have the competence for medical specialties like neurology , nephrology, psychiatry etc.? If the answer is NO then the problem to be solved is to organise the comming together of all these specialists to the patients benefit for diagnosis and therapy as well. Specialised geriatric wards would be helpful if beyond this general geriatric competence the knowledge of other medical disciplines is always at hand. This may be done by installing an obligatory consultancy service by the other specialties for elder people and vice versa by looking at all aged persons in other wards by the geriatric specialist to identify geriatric multimorbidity because geriatric problems are often overseen by specialists due to a specialist view.

As an example about the importance of polypharmacy and the question put, I draw your attention to the dependence of the risk of hip fracture due to psychotropic drug use which is from a publication of Ray et al. in 1987. You can easily see that the occurance of hip fractures conincides with the dosis of drugs per day.

In Germany Borchelt 1995 (Berlin study of aged people) investigated that:

People elder than 70 , which you know suffer from multimorbidity , receive on average 3 different medical drugs per day

35 % of people over 70 years receive 5 to 8 different medical drugs per day

15 % even receive more than 13 different medical drugs per day

The group of 80 to 85 receives the highest number of medical drugs to take per day

Typical consequences of this polypharmacy are

1 falls and mortality 2 risk of interactions

3 cascading of prescriptions 4 poor medication adherence

In another study with patients over 60 the number of not desired side effects and interactions is more than double as with younger people, the higher the number of medical drugs, the higher will be the adverse drug events.

Up to 5 medical drugs at the same time go along with (3,4 % pharmacological interactions), but more than 6 medical drugs at the same time go along with (25 % adverse drug events.)s Mühlberg und Platt already realized in 1999

And the netherland study group of opondo an coworkers found by a systematic review of 19 studies in 2012 that the median rate of inappropriate medication prescription was 20% in elderly persons in primary care.

Best greetings

Wolfgang

Wolfgang Seger , about inappropriate medications

with special regard towards cognitive derangement

based on my clinical experience and research in this field. i found that well designed and comfortable place has to be provided for elderly people. It doesn't protect their safety only but also it affect their satisfaction and psychological status and finally their health status. you can find the attached abstract.

I think oldness is a critical period as like as other critical situations that needs a separated ward.

i feel special attention is required for the elderly people. Criticality is more like fall risk, dementia, dependence on others for certain activities etc.

Absolutely. They need their needs-centered care and care environment. For the older adults, "fall," "urinary infection," "bedsore," and so on are a high risk.

May be needed due to polypharmacy and medical conditions of such patients.

Ali Shlash

just downloaded [& recommended] through another discussion in ResearchGate, Mauro

The real question the separation what is the elderly can be managed optimally in outpatient vs inpatient care environments.

Elderly population increased allover the world with increasing life span and life expectancy. They suffered from multiple health problems (co-morbidity)with multiple medication prescriptions. They are facing special geriatric symptomatology such as fall, confusion and urinary incontinence. They need special care by professionals in this field such as geriatric physicians and gerontological nurses and also special hospitals, wards, clinics, and health centers.

The old and the elderly as are children is a population at an extreme end of human life cycle with adverse challenges arising from their gradual immobility and physical inactivity. They are most in need of care , just a proper even as a child is nursed are they supposed to be nursed even with equal care and diligence.

The Current Evidences project high need for caring elderly separately. Depending upon the the health need of elderly there are many specialized health services and treatment for elderly. It is always appreciated for better health outcome to have separate wing for elderly.

The elderly need advocates wherever they are.

They have special needs and need special wards!

at least, special wards may play a tutorial role

In view of all the comments, given by Sir Wolfgang Seger, i would like to know as whether these many drugs are really needed for the elderly patients? in such cases what is the role of "Alternative medicine which apparently palliative and comparatively less side effects,

Are we able to visualize the concept of "wellness" in healing so that elderly people come across less side effects and good quality of life.

In view of the same, with rising burden of NCDs and Elderly illness, How alternative medicine can be integrated effectively for assuring quality of life of elderly.

non-pharmacological treatments for pain are worthwhile, Mauro

It has been shown through research that older people who are frail and vulnerable to poor outcomes related to hospitalisation benefit from a targeted approach from multidisciplinary clinicians skilled in meeting the multidimensional needs of this cohort. It is of course important to differentiate between the frail older cohort and those older people who are physically and cognitively strong. For the frail cohort, comprehensive geriatric assessment (CGA) is the corner stone of best practice and is most effectively achieved in a ward that is focussed on this approach. It can be done in more medically orientated settings but there is plenty of evidence that suggests this approach is less effective and efficient. Moving the ethos of care from specialist medical models to a holistic general approach might explain this. Given that this cohort are at high risk of deconditioning and development of geriatric conditions leading to longer hospital stays, it makes sense to have nurses, allied health and doctors skilled in developing CGA in a setting that actively addresses risk of functional decline, delirium and other adverse outcomes that older people are at risk of.

Andre Catrice

very well; just few more references

Age is related to functional capacities of all organs in life from birth to old age. However, there exists wide variations among individuals related to many factors. Elderly population is a special and vulnerable group just as children are, which require specialized care in all settings being it institutional or home due to natural degeneration and failing organs functions

the current pandemic is putting geriatricians among the most requested specialist: literature is clear [e.g.: see JAMA]

Most of the elder have chronic multiple diseases that don't need emergency treatment. In my opinion, it is better to be managed in sanatoriums and refer to hospitals when they have acute diseases. On the other hand, Older patients may develop incontinence, immobility, instability, and acute delirium or confusion in response to virtually any disease.