Identifying modifiable factors to improve quality for older adults in hospital: a scoping review.
BACKGROUND
Traditional ways of viewing hospitalisation do not always recognise how elements within the hospital environment contribute to disability. Four theoretical dimensions of older adult-hospital environment fit have been proposed in previous research on elder-friendly hospitals: social climate, physical design, care systems and processes, policies and procedures; however, modifiable factors for each dimension are not yet identified.


METHODS
Exploratory iterative design guided by Arksey and O'Malley (2005, International Journal of Social Research Methodology 8, 19) scoping review methodology.


METHODS
We undertook a scoping review of primary research related to hospitalised community-dwelling older adults. Keys search terms and criteria were used to identify relevant articles with modifiable factors extracted from articles meeting study criteria.


RESULTS
A total of 66 studies were included and evaluated for modifiable factor mapping. We were able to map all 66 studies to the four dimensions. The majority of included studies described care systems and processes, with little relating to social climate, physical design and policies and procedures. Thirty-nine potentially modifiable factors were identified and mapped to the theoretical dimensions according to four overarching themes: models of care; assessment of potential geriatric issues; targeting care to a specific clinical issue and supporting transitions home themes.


CONCLUSIONS
The dimensions of older adult-hospital fit help us to organise key features of an elder-friendly hospital and identify potentially modifiable factors. Although it makes intuitive sense to cluster and organise according to the dimensions to help with understanding, this tells us little about the synergy of interactions and hierarchical relationships. Our results highlight the importance of competent gerontological nursing in care for hospitalised older adults and the need for further understanding of the older adult and family as a unit of care.


CONCLUSIONS
Registered nurses have a leadership role to ensure safe quality care for older people in hospital. This leadership role can be framed in interventions that focus on fixing the fit between what older people need and what the hospital environment provides. Modifiable factors for improvement are within the scope and competency of the registered nurse.
Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.
Belinda
B
Parke
Kathleen F
KF
Hunter
Anne-Marie
AM
Bostrom
Thane
T
Chambers
Christina
C
Manraj
D000368:Aged; D005851:Geriatric Nursing / Q000592:standards*; D006760:Hospitalization; D006801:Humans; D009741:Nursing Staff, Hospital / Q000592:standards*; D010043:Outcome and Process Assessment, Health Care; D058996:Quality Improvement