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The Older Adult R&D Team at City University, London, has published a set of evidence-based guidelines for the acute care of older people that are primarily targeted at nurses but also have relevance for other clinicians.

The evidence-based best practice statements are a resource for staff who work with older people, all or some of the time in general acute service,: to support and guide their own practice, and to help them explain to others what best care for older people involves. They update the 2001 Standing Nursing and Midwifery Advisory Committee (SNMAC) evidence-based principles, standards and indicators for nursing care of older people in the acute phase of illness, published at the same time as the National Service Framework for Older People. Their relevance is heightened by the policy context of improving patient experiences, because of their explicit aim to do just this.

The best practice statements are based on the findings from a systematic review aimed at finding out about the acute care experiences of older people and relatives1. The review’s findings highlighted the value that older patients and their relatives place on the relational rather than the technical aspects of care, and the important role that all acute care staff, have in:

Maintaining identity: “see who I am”
Patients want healthcare professionals to know what is important to them, and relatives want healthcare professionals to value what they know about the patient.

Creating community: “connect with me”
A connected and two-way relationship with staff gives patients and relatives the reassurance that staff will care for them and meet their needs.

Sharing decision-making: “involve me”
Patients and relatives want to understand what is happening, and to be given ongoing involvement in decision-making.

The review illustrates that these three key messages have particular relevance for older people with dementia and/or delirium; with difficulties communicating, hearing or understanding; from ethnic minority groups, especially where there is a language difference; with low functional ability/ high physical disability; and for people not accompanied by relatives or others. It is probable that the key messages also hold particular relevance for people at the end of life, but the dearth of research here meant that this possibility could not be explored.

These findings reinforce the importance of relationship-centred care in which the quality of engagement between patients, staff and practitioners is paramount in promoting the wellbeing of all involved. A best practice statement is included for each of the three key messages and they also provide an underpinning philosophy for all the best practice statements. Other best practice statements are based on existing systematic reviews, clinical guidelines and consultation with an expert panel. These statements cover:

• Caring for people with mental health needs
• Caring for people with palliative care needs
• Caring for people at end of life
• Meeting needs for nutrition and hydration
• Promoting continence
• Promoting mobility and preventing falls
• Preventing and managing pressure ulcers

The guidance comes in the form of a CD and a booklet. The best practice statements are set out in full on the CD, along with links to videos of patient stories and to other resources. The booklet includes ideas for individual nurses and nursing teams to work with the best practice statements to identify existing good practice and to articulate the support they need to maintain and build on this. The CD and booklet have recently been distributed with the journals Nursing Standard and Nursing Older People. The material, including a link to the systematic review, can also be accessed here . Spare copies of the CD can be requested from me (contact information below).

Jackie Bridges
Lead Author: BPOP Guidelines
T: 020 7040 5469

BGS Newsletter, February 2010
Issue 25 ISSN 1748-634000 25