Research improving education and healthcare for older Australians
In the WHO decade of healthy ageing, Queensland translational research is leading age-friendly education and healthcare. Professor Nancy Pachana and Professor Alison Mudge point out that underpinning this work is the premise that as a society, we care about older people, value their perspectives and experience, and see these endeavours as part of a more holistic move towards an age-friendly world.
Professor Nancy Pachana is BDHP’s Theme Leader for Ageing and leads The University of Queensland’s Age-Friendly Initiative. In 2020, UQ became the first age-friendly university in the Southern Hemisphere.
“With the World Health Organisation (WHO) declaring 2020-2030 the Decade of Healthy Ageing, it’s time for institutions, such as universities and hospitals, to lift their game when it comes to being age-friendly,” Professor Pachana said.
“Ageing brings dividends, not simply burden. What we can now prove is that age-friendly initiatives deliver benefits to people of all ages and drive positive social, policy, health and wellbeing initiatives within Australia and beyond.
“As part of UQ’s Age-friendly Initiative, we have committed to ten global principles, and across the many missions of the university, we promote the value of ageing and work to minimise ageism and ageist thinking. We have also introduced services that support older people to pursue their study and life goals, such as UQ Healthy Living in Toowong. The facility has an outreach to local hospitals and health centres, and offers multidisciplinary rehabilitation to people who have experienced a setback in their health.
“We now ask mature-aged students and older people who are using the university, to help us co-design the space and how we interact there, so that we make the university as age-friendly as possible. With our vibrant Aboriginal and Torres Strait Islander Studies Unit and health care initiatives that invite Aboriginal and Torres Strait Islander peoples on to campus, we’re also looking to understand if there are any barriers to their full participation.
“We’re also going one step further and working to make our public-facing institutions, like our art museum and sports complex, dementia-friendly. We will invite people living with dementia to evaluate whether these facilities are welcoming, with the overarching goal of making the entire university dementia-friendly one day.
“For longer than a decade, we’ve known that despite an increasing percentage of people being older, the number of people trained to treat older people within various healthcare disciplines has lagged way behind. UQ is committed to reducing this gap by expanding the number of placements where students interact with older people and strengthening our links to local hospital and health services.
“UQ has some excellent research looking at the various aspects of ageing. The Brisbane Diamantina Health Partners supports this theme, promoting cutting-edge research and highlighting early career researchers and research clinicians in the field,” Professor Pachana said.
Clinician researcher Professor Alison Mudge is on the frontline when it comes to making Queensland hospitals more age-friendly. A physician based at the Royal Brisbane and Women’s Hospital (RBWH) Professor Mudge is a member of the BDHP Ageing Theme leadership team. She is the clinical lead for Eat Walk Engage, a comprehensive multi-disciplinary program improving the care of older people in hospital. She explained why we need to create age-friendly hospitals.
“You are much more likely to need hospital care as you become older because we accumulate more diseases, but you’re also more likely to be vulnerable to hospital-associated harms,” Professor Mudge said.
“Some of this is because hospital care models, teams and environments were never designed with older patients in mind. Demographics have shifted, especially in developed countries, but we have fallen behind in caring for people in an evidence-based way. Underlying this, hospitals, like other institutions in our society, are fundamentally ageist, and older people tend to be invisible in our systems.
“A recent WHO global report shows that about 50 per cent of people are ageist. Ageism is an interesting form of prejudice because it is discrimination against our future selves. There is still emerging evidence about how we might tackle ageism in our institutions and at a societal level. Some of the work showing promise is education and training and mixed-aged experiences, like the ABC’s Old People’s Home for 4 Year Olds. Improving integration within our society is a way that we can stop seeing older and young people as ‘other’, and see it all as ‘us’.
“The thing about an age-friendly hospital is that it doesn’t disadvantage younger people. It can reduce the length of hospital stays and the additional care required at home, improving the experience for all patients and staff,” Professor Mudge explained.
The Eat Walk Engage program began at the RBWH and has since shown great results in a large trial across four hospitals, including the reduction of delirium, the most common hospital-associated harm in older people, by almost 50 per cent. The program is now running in 20 Queensland hospitals as part of a $30 million Queensland Health annual investment in improving healthcare for older people. Professor Mudge said this is the largest scale initiative of its type in Australia.
“We’re working actively with clinical leads and clinicians on different wards to embed the Eat Walk Engage principles and to look at what we’re doing well and where there is room for improvement,” she said.
“We always start by talking with older people on the ward to find out what their experience has been like and what they feel are barriers to fundamental care like mobility, social activity, good nutrition and hydration. These all sound like simple things, but the challenge is how to make sure we consistently deliver them to all the patients in a fast-paced system with many competing priorities.
“BDHP helped to fund a qualitative study, which looked at the barriers and enablers to implementing age-friendly hospital care. Our research found that age-friendly care requires empowering the local health leaders close to the action, investing in evidence-based care and in skilled teamwork, ensuring teams have knowledge about caring for older people and understand how to work well in a team.
“We often have a lot of training to do on the wards and getting teams working together, because older people often have several things wrong with them and require a team of clinicians. We’re also always looking at how we can make hospitals less-challenging environments for older people.”
Professor Mudge’s team aims to do a comprehensive evaluation of the program and its impact on older people and clinicians’ experience. They are also looking into whether their model can be adopted in health settings and jurisdictions.
“With BDHP support, through an MRFF grant, we are studying the impact of better staff education about cognitive impairment combined with the principles of the Eat Walk Engage program on reducing the length of stay for patients in a rehabilitation facility. These findings will be available shortly,” Professor Mudge said.
“We’re also doing a pilot study at Flinders Medical Centre in Adelaide to see how well our model translates to other jurisdictions, and we have our first international site in Cork in Ireland, which has a strong history of age-friendly care. From these experiences, we will learn about the common elements that all hospitals could adopt and what we need to adapt for different settings or healthcare systems.”
Declared is an upcoming conference about delirium (registration closes 6 June 2021) in Brisbane on 8-10 September 2021 www.declared2021.com
Articles about ageism, age-friendly hospitals and the Eat Walk Engage program:
- WHO Global Report on Ageism (18 March 2021)
- The University of Queensland Age-Friendly Initiative
- Qualitative analysis of challenges and enablers to providing age friendly hospital care in an Australian health system | BMC Geriatrics | Full Text (biomedcentral.com)
- Eat Walk Engage: delirium prevention for acute care – Australian Journal of Dementia Care
Professor Nancy Pachana
School of Psychology, The University of Queensland
UQ Ageing Mind Initiative Co-director
BDHP Theme Leader for Ageing
Professor Alison Mudge
School of Clinical Medicine, The University of Queensland
Physician, Royal Brisbane and Women’s Hospital
Clinical Lead. Eat Walk Engage