Over two years ago, I joined the Occupational Therapy department in University Hospital Limerick, where I continued to follow my passion for advancing older persons care within the acute setting. I commenced my current role as a senior occupational therapist in the Emergency Department in late 2018 as part of the OPTIMEND study. This randomised controlled trial explored the impact of early assessment and intervention by a team of Health and Social Care Professionals (HSCPs) on the quality, safety and clinical effectiveness of care for older persons in the ED. It was a nationally funded study and such a model of care was a new venture for the ED at University Hospital Limerick. Findings from the study demonstrated that HSCPs can positively impact patient outcomes with respect to time spent in the ED, discharge home and overall satisfaction with their ED experience. Two years later and the team are fully embedded in the ED and engage in senior decision-making regarding older persons care and outcomes, in collaboration with Emergency Medicine staff.
The interdisciplinary HSCP team comprises an occupational therapist, physiotherapist and medical social worker; together we foster the ethos of “every hours counts” when older persons present to the ED. We endeavour to commence a holistic assessment of a person’s functional, cognitive, and psychosocial status in a timely manner and focus our attention on patients with a lower illness acuity and urgency, for example, non-injurious falls . One of the first questions I tend to open my assessment with is: “What would you like to see happen today?”. Such an open-ended question can provide rich insights into a patients will and preferences in broad terms and gives us a greater appreciation of the challenges patients may face. Much time is spent on subjective information gathering, particularly for older persons that present with a nonspecific complaint. The time spent exploring the reasons and triggers that led to the ED presentation are invaluable and assist us arrive at person-centred solutions for the patient.
Invariably, patients require onward referral to alternative care pathways following discharge from the ED to support well-being and independence in their homes and communities. As we emerge from the COVID-19 pandemic, the paradigm shift from acute, episodic care to longitudinal, coordinated and integrated care has never been more imperative. In clinical practice, we have seen first-hand the devastating consequences this virus is having on our older population – from high levels of mortality and illness severity to the deconditioning effect months of cocooning at home has had on our oldest old. The loss of cognitive and emotional wellbeing as a result of social isolation and loneliness is being felt across the trajectories of care. Within the ED, we are seeing older persons present with manifestations of social isolation, reduced levels of physical activity and associated sequelae. Exploring mechanisms and referral pathways with patients to support and facilitate an increase in physical, cognitive, and emotional activity has been to the forefront of clinical practice, most especially in recent months.
If global pandemic has taught us anything, it is to appreciate the longevity dividends that our older population provide to society as a whole.