Table 4 Management of concerns

Cognitive impairment

Support optimal cognitive functioning through effective treatment strategies that promote functional independence of all patients, including elderly patients with dementia.

- Early detection and treatment of elderly risk factors (hypertension, diabetes, hyperlipidemia, etc.)

- Discuss cognitive change in the patient with the multidisciplinary medical team and refer it to the specialist department as appropriate.

- To address the behavior caused by dementia, first pursue non-medicinal treatment (obesity control, depression management, exercise, and smoking cessation).

Depression

Prevent situations that can cause or exacerbate depression.

- Find medications that aggravate depression early and readjust the medication.

- Involve the patient, family, and caregiver in a depression care plan, and encourage them to engage in hobbies and exercise with the patient.

Delirium

Prevent situations that can cause or exacerbate delirium.

- Aim for early detection of risk factors in elderly people (dementia, drug changes, hydration, critical illnesses, visual disturbances, environmental changes) to prevent delirium, mediate risk factors, and monitor intervention effects.

- Educate the patient, family members, and caregiver about delirium, and let them participate in delirium management.

- Include the management of potential antecedents of delirium (constipation, malnutrition, hydration, urinary catheter, multidrug use, pain, blood sugar elevation) in the multidisciplinary team’s individualized care plan.

Polypharmacy

Reduce the risk of drug interaction.

Review medicines to prevent and resolve potential side effects.

- Educate the patient, family members, and caregiver about medicines.

- Review medicines with pharmacists or physicians, and then develop a sustainable strategy to manage medications the patient is taking.

- Check drug interactions every time the doctor changes drugs, and ensure there are no drug errors.

- Re-evaluate and record medicines on a daily basis.

Functional decline

Maintain the patient’s functional athletic ability.

- If it is not medically contraindicated, move as soon as possible after acute illness occurrence.

- If necessary, provide mobility aids.

- The use of appropriate shoes is recommended. Consult the patient and caregiver regarding the use of hip protectors.

- Identify the risk factors for functional mobility loss and personalize multidisciplinary interventions for optimal mobility (e.g., individualized exercise programs).

- Avoid using restraints. Assess whether the patient’s family can participate in interventions that improve the patient’s ability to move. Include the patient’s family in the planning of the patient’s meals, exercise program, and gait.

- Provide the patient and their family with information on the risk factors that may limit ability to move.

Dysphagia

Provide safe meals and attitudes to prevent pneumonia caused by dysphagia.

- Monitor malnutrition and airway aspiration due to dysphagia.

- Identify the current dietary content and provide a diet that can prevent dysphagia.

- Educate the patient, family members, and caregiver about safe meals and postures.

Malnutrition

Provide proper nutrition.

Identify and avoid hospital procedures that cause nutritional imbalance.

- Monitor daily food and water intake, and measure the weight of the elderly.

- Evaluate the risk factors (dehydration, intravenous fluid, dysphagia, oral illness, delirium) that may affect nutrition and hydration balance.

- Set goals for food and water intake with elderly patients, and record progress toward achieving goals.

- Ensure that the patient, family members, and caregiver are part of the nutrition and water management plan and that they can visit to help the patient at meal times.

- Record the nutrient/ hydration status and plans at transition or discharge.

Urinary incontinence

Maintain urination function through urination management and healthy lifestyle practice. Urinary catheters are used only when medically necessary.

- Ensure the patient is using an appropriate urinary catheter.

- Consider other methods that can be used instead of urinary catheters (e.g., regular urination training).

- Evaluate prostate health in male elderly patients.

- Insert urinary catheters intermittently for urine culture and for management of early urinary obstruction.

- For patients with symptomatic urinary tract infection, remove urine catheters for longer than 14 days before urine culture. This prevents contamination of the catheter and improves the clinical outcome of antibiotic therapy.

- Prevent catheter damage and improper removal of the catheter by using a catheter fixation device; this also increases comfort.

- Indicate symptoms of urinary tract infection to the patient, family, and caregiver.

Fecal incontinence

Maintain normal bowel function through the proper use of regular bowel movements and emollients.

- Check the bowel movement pattern.

- Perform physical examination and abdominal x-ray.

- Distinguish temporary incontinence and continuous incontinence.

- Depending on the degree of constipation, treat with non-medicines and medicines.

- Provide training to the patient, family members, and caregiver on maintaining the patient’s intestinal health after discharge.

Pain

Assess and manage acute, chronic pain. Identify common causes of acute, chronic pain.

- Implement various non-pharmaceutical approaches as the first intervention for effective pain management.

- If non-medicinal approaches are inadequate, use appropriate medicines.

- Drugs should be used at low doses, with increments administered gradually.

- Start a regularly prescribed dose with a pro re nata (PRN) dose to prepare for sudden pain.

- When using medicines to manage pain, monitor the side effects of medicines and drug interactions.

- Monitor and evaluate all pain management interventions.

- Allow the patient to manage the pain by him/herself.

- Provide the patient, family members, and caregiver with education on pain.