Specialised environments to meet the needs of older people

As more people are cared for in the community an increasing proportion of those admitted to hospital can be categorised as frail. This encompasses key clinical syndromes recognised by geriatricians as the 'bread and butter' of geriatric medicine, namely; loss of mobility; falls; confusion; incontinence and polypharmacy. Older hospital inpatients showing these signs of frailty are at particular risk of adverse outcomes such as death or institutionalisation. Modern general hospitals may contribute to this with their technological focus. If acute hospital admission is unavoidable, processes can be adjusted to lessen the impact on the frail older person. They need a comprehensive assessment with a more broad-based diagnostic/therapeutic approach to care than younger patients. Physical environments can also be adjusted with a need for safe flooring, safe wandering space, orientation cues such as large clocks and calendars and aids to mobility such as hand rails and raised toilet seats.