unit. This role does not require a new staff position but may reassign an existing nurse champion who has a vested interest in geriatric care. Important characteristics for the selected nurse include having a passion for caring for older adults, a dynamic personality, and skills to quickly build rapport to motivate patient success. If a dedicated staff member is not available for Healthy Aging, an alternate strategy is to have all clinical team members participate in early mobilization activities. This includes having a comprehensive nursing assistant team wherein constant out-of-bed mobility and human connection can be offered. The role of the nursing assistant is to orient the patient to the program and the 4Ms, as well as establish a program pathway with the patient that is focused on mobility (e.g., mobilization schedule), sleep hygiene, addressing what matters in life and in health, delirium prevention with conversation, opening blinds, and maintaining a daily routine. Nursing assistants also lead mobilization of patients daily. Healthy Aging The Sharp HealthCare Healthy Aging team works to prevent cognitive and physical decline during hospitalization by promoting sleep hygiene and early mobility across every unit in the hospital. Healthy Aging is designed to prevent physical and cognitive decline through strength maintenance activities and sleep hygiene. The program requires an operational workflow that consolidates diagnostics and therapeutics into daytime hours instead of a standard workflow that may involve frequent night interruptions for labs, personal care assistance or general cleaning. When caregivers are not prioritizing patients’ wake and sleep routines, nor encouraging wakefulness similar to the pattern at home, patients are more at risk for developing delirium and extending their hospital stay. Healthy Aging enables patients to maintain better cognitive and physical function, increases their ability to achieve care goals, and leads to patients being able to leave the hospital sooner. Eligible patients are those who are either acutely or chronically ill, are age 65 or older, and demonstrate independence immediately prior to their illness. Healthy Aging is the foundation upon which other components of Generational Health are built and has been deployed across all hospital units and floors. The Healthy Aging team includes clinical staff and ancillary service experts. Healthy Aging responds to patients’ needs and provides interventions to older adults by focusing on a care schedule that is safest for them. To reinstate the patient’s voice in the care plan, Healthy Aging uses patients’ goals to align scheduling of daytime activities focused on promotion of sleep, directed therapy sessions for age-specific needs, delirium mitigation, medication management, patient-centered care, and focusing on individual goals. For example, changes may include increasing exposure to natural light during the day, additional interactions with staff, and improving sleep hygiene by avoiding clinical processes that disrupt sleeping hours. Tasks such as housekeeping, labs and vitals are rescheduled during non-sleeping hours. After an acute hospitalization, patients are also supported with follow-up phone calls and assurance that there is a plan for each identified area of need. At Sharp, this is a cross-departmental effort and requires a champion within each participating In Healthy Aging, patients’ initial mobilization safety plans are conducted by the bedside nurse. Physical therapy consultations are reserved for patients who have demonstrated a need for a higher level of intervention, such as skilled therapy. This shift in practice addresses the risk of inactivity for older adults. This approach also avails the physical therapist to focus on patients with greater needs. “I can take a 25-year-old patient and put them in an MRI machine at 3 a.m. without consequences to sleep-wake hygiene, or their cognition or function the following day. You cannot do the same thing for a frail, vulnerable or cognitively impaired patient without consequences to sleep-wake hygiene or cognition. Once delirium develops, the patient loses the ability to participate in active rehabilitation and loses ground with functional recovery.” — Diane Wintz, MD, Medical Director for Generational Health and Trauma at Sharp Memorial Hospital 7
