HSJ readers emphasied that effective and appropriate communication, as well as setting realistic expectations, are important parts of patient centred care for older people

Elderly man in wheelchair with smiling healthcare worker

What works to change culture in care depends most on local leadership and staff competence

Hospital staff introduce themselves upon entering a dementia patients’ room

“In one London hospital staff introduced themselves each time they entered the patient’s room and told them what they were there to do.This is simple and helps put dementia patients at ease and makes less work for relatives.”

At a glance awareness that a patient has dementia

“The trust I work for has a simple sign placed above the bed – it is a butterfly symbol.

“This signals to any member of staff that the patient has a memory loss problem and might not remember something they are told or have difficulty understanding time or day.

“My mother is in another hospital where this is not the case and I have to keep repeating the issues to staff so they are aware. Otherwise they believe everything she says and do not adapt to the situation in a helpful way. They also need to tell me things so I can remind my mother and be fully involved.”

Using short videos to communicate more effectively to older people and staff       

“We have been testing the use of simple short videos to:

  • help explain the journey through hip and knee replacement procedures;
  • help older people avoid and manage conditions such as preventing falls and pressure ulcers, and managing diabetes or dementia; and
  • train staff to care better for the particular needs of older people using techniques such as the ‘six Cs of dementia care’ and tips for preventing falls in a hospital.

“There are so many opportunities to help and explain to the individual and their family/carers in order to ease the anxieties that can build as a result of ignorance, especially when staff are short of time. 

“The message can be much more consistently delivered, allowing staff time to deal with much more personal and individual issues.”

Teach communication skills to clinical and nursing staff      

“Help staff through experiential learning to understand that not all older people are hard of hearing so they do not need to be shouted at. 

“We also encourage staff to speak to older people as intelligent adults and not children.

“As other readers have said: find innovative ways to improve confidentiality so nearby patients and visitors do not overhear confidential and sensitive information.”

Safety first 

“Frail elderly patients are particularly vulnerable to care issues arising from medium to long term hospital stay. For example, pressure ulcers can extend stay and lead to serious complications.

“Each patient should undergo a needs assessment on admission that informs a care package for the duration of their stay.

“Relevant NICE guidelines for management of patient safety, such as pressure ulcers, should be mandatory components of the care package and the whole package should be subject to regular clinical audit until the patient is discharged.


“Conversations and information given to patients that should take place in a private setting are often heard on wards. The drawing of a curtain offers very limited privacy.”

Patient centred care     

“Having just experienced healthcare for the elderly in a district general hospital in the South West with my father who has had Parkinson’s disease for 27 years, and worsening dementia in the last few years, I could not understand the strict visiting times of 2p,-4pm and 6pm-8pm on the wards when there were not enough staff to meet individual patient needs.

‘Discuss the patient’s care with them and how their transition from hospital to their home will happen’

“Although an exception was made for my mother, who has been my father’s 24/7 carer for several years, the nursing staff did not maximise the opportunity that this provided. At no time in his two weeks in hospital did a nurse obtain the necessary information from my mother about how his daily living activities were met prior to this admission. This information would have been necessary in order to write a credible nursing care plan.

“I can only conclude that strict visiting times were necessary to prevent the majority of relatives observing the lack of care available for their loved ones.

“I work in neonatal care and would suggest that healthcare of the elderly could learn a lot from the philosophy of neonatal and paediatric family centred care where the parents have 24/7 access to their children and continue to provide the majority of care required with support from nursing staff.

“When the aim is to discharge as soon as possible, ensuring that the people who are going to support the patient to return home quickly are involved and aware of the continuing care required will help streamline the process.”

Realistic expectations of medical care              

“Dementia and respiratory and cardiac diseases are some of the common comorbidities in the frail elderly. 

“Realistic expectations of curative care and palliative care benefits worked out holistically need to be available for discussions with families to make appropriate long term care decisions.”

Put the patient at the centre of their care by communicating with them, not at them              

“Discuss the patient’s care with them and how their transition from hospital to their home will happen.

“Discuss how they will obtain further supplies of medication, working with them to ensure that their local pharmacy has a copy of their discharge medication and can support a three way conversation with the patient’s GP to obtain medication that they will need on an ongoing basis.

“Discuss any other actions that need to occur for an effective transfer back to their home.”