12 October 2020
People who are older and frail are more likely to struggle after even a minor illness or a change in medication or environment. Sarah Biggs from Gloucestershire has been a public contributor to research underpinning the Information About Me campaign, which aims to help staff prepare an older person for leaving hospital when they are ready.
Sarah’s late mother endured a lengthy hospital stay following a fall aged 93:
My mother had been living in a care home, where she was very happy and settled. She had a fall and was sent to hospital to check whether she had a broken hip. I was with her when she was being admitted. The x-rays were inconclusive so they were going to do a CT scan. In my head, she was either going to be found to have a fracture which would need repair, or not, and would therefore be discharged back to her care home.
I visited her every day. She had good days and bad days, but because she kept being moved to different wards, she didn’t know where she was. And I never really knew who was looking after her.
After a few days, she was diagnosed with a fractured pubic ramus, which is painful but can’t be repaired with surgery. She wasn’t weight-bearing before she went into hospital, so my argument to anyone who would listen was, “Can she please go back home with some pain relief? Back to where she’s happy and well cared for?”
Ten days went by. I never knew who was looking after her, or whether she was under the orthopaedic team or the geriatric team. She was pretty confused by this point.
I was then told that her blood test results weren’t normal so the consultant wanted her to stay a bit longer. I never knew who the consultant was. I asked what ‘normal’ bloods look like on a 93 year old, and what staff were proposing to do. I didn’t think it was appropriate to intervene for something that she hadn’t been admitted for.
Two more days went by before my mother was finally returned to her care home. She had gone from being pretty lucid, and fairly well hydrated and well nourished, to not really knowing where she was or what was going on.
She wasn’t capable of saying she wanted to go back home, because she had become quite confused. And at no point was I asked whether I felt it was safe for her to go home, or how I confident I was that she would be well cared for.
You need someone who can say: “This is what I believe this person would want”. Because some patients might want to be in hospital, they might feel much safer there, but unless you ask that question and document it, you’re never going to know.
There was a lot of investigation going on, but sometimes more fundamental information is needed, not just what’s medically wrong with a person. Many elderly patients aren’t used to feeding themselves, for example – my mother was being helped quite a lot before she had gone into hospital. Sometimes it’s a matter of making sure they’ve got what they want to eat and what they want to drink, and in a hospital that’s often quite difficult.
Staff need to understand what the person’s baseline was before they went into hospital. If they can walk and talk and dance and listen to music and be independent, then they need to know that. But if they can’t do any of those things, and this is how they currently function and this is the help that they get, then that needs to be understood too. With my mother, I never had the chance to set this out – nobody seemed to be listening.
What would have been most helpful when my mother was in hospital would have been having a single point of contact at any time, who would have known all the information about her, and been involved in decision-making. That’s why I want people, who might be in a similar situation now, to know that they can fill in an Information About Me form and it could make a difference.