Older people are one of the biggest populations requiring hospital care, and the demand is expected to rise. There is a compelling need to transform hospital environments to meet older-people physical, psychological, and emotional needs. In the UK, certain hospital circumstances such as ward configuration, mealtimes, noise levels, and visiting hours can be detrimental to patients admitted with delirium and to those living with dementia. In rehabilitation settings, lack of meaningful activities, isolation, and boredom are additional key challenges.

Models of good hospital practice catering for old people exist, both in the UK and internationally, and there is strong evidence for their clinical effectiveness. Environmental strategies to maintain orientation and enhance safety in hospital are crucial for a positive experience. Arts-based programmes in acute care settinsg can improve the experience of a hospital admission.

A cultural shift is warranted to champion the delivery an elderly-friendly service. Creating the right environment requires a hospital-wide system, a ward-based service, and a specially trained clinical team. In this chapter we will present examples of essential ingredients for hospitals and wards, and desirable qualities in clinicians who work in collaboration to deliver the best outcomes for an older population.