THE YALE GERIATRIC CARE PROGRAM - A MODEL OF CARE TO PREVENT FUNCTIONAL DECLINE IN HOSPITALIZED ELDERLY PATIENTS

Objective: To describe the structure and implementation of the Yale Ge riatric Care Program, an innovative, nursing-centered model for develo ping geriatric nursing expertise throughout an acute-care hospital. De sign: Descriptive study of an intervention in a prospective cohort of patients. Setting: University teaching hospital. Patients: Two hundred forty four patients aged 70 years and older on four non-intensive car e intervention units during the study period (july 9, 1990 to July 31, 1991). Intervention: The Geriatric Care Program involved an integrate d model of primary nurses, specially trained unit-based geriatric reso urce nurses, gerontological nurse specialists, and geriatric physician s. The intervention included surveillance and identification of frail older patients, unit-based geriatric educational programs for all nurs es, special education and support for the geriatric resource nurses, a nd twice-weekly rounds of the Geriatric Care Team. Results: The Geriat ric Care Program has been successfully implemented on four units. The interventions ranged from general clarification of goals in 226 (92%) to specific recommendations for management of immobility in 100 (41%), bladder/bowel problems in 99 (41%), pressure ulcer treatment or preve ntion in 61 (25%), confusion evaluation or management in 62 (25%), and adjustment of medications in 43 (18%). Overall, 68% of the specific r ecommendations were documented to have been implemented. Barriers to i mplementation of the program have included initial difficulties with r ecruitment and retainment of geriatric resource nurses (due to high nu rsing turnover and the increased time commitment required), breakdown in communication and carry-over of recommendations between nursing shi fts, and obstacles to communication between the nursing and medical st aff. Conclusions: An innovative model of care, in which geriatric nurs ing was integrated as part of standard nursing care on selected medica l and surgical units, has been designed and implemented. Evaluation of the effectiveness and costs of this intervention are currently underw ay.