Changing Hospital Care For Older Adults: The Case for Geriatric Hospitals in the United States

Abstract

Hospital care of frail older adults is far from optimal. Although some geriatric models of care have been shown to improve outcomes, the effect size is small and models are difficult to fully implement, sustain and replicate. The two root causes for these shortcomings are competing interests (high revenue generating diseases, procedures and surgeries) and current hospital cultures (for example a culture of safety that emphasizes bed alarms and immobility rather than frequent ambulation). Geriatric hospitals would be hospitals completely dedicated to the care of frail older patients, a group which is most vulnerable to the negative consequences of a hospitalization. They would differ from a typical adult hospital because they could implement evidence based principles of successful geriatric models of care on a hospital wide basis, which would make them sustainable and allow for scaling up of proven outcomes. Innovative structural designs, unachievable in a typical adult hospital, would enhance mobility while maintaining safety. Financial viability and stability would be a challenge but should be feasible, likely through affiliation with larger health care systems with other hospitals because of cost savings associated with geriatric models of care (decreased length of stay, increased likelihood of discharge home, without increasing costs).

Personalized, interdisciplinary patient pathway for cross-sector care of multimorbid patients (eliPfad trial): study protocol for a randomized controlled trial

“…Predictors for these unplanned readmissions are sociodemographic factors like higher age, multimorbidity, and certain diagnoses such as heart failure, coronary heart disease, chronic kidney disease, and chronic obstructive pulmonary disease (COPD) [ 8 – 10 ]. The main treatment goal for these patients should be to preserve their autonomy and quality of life by avoiding rehospitalization, as recurring hospital stays have been shown to cause undesirable medical consequences such as delirium or falls [ 11 ] and economic effects in terms of higher health insurance expenses [ 3 ].…”

Mobility outcomes and associated factors of acute geriatric care in hospitalized older patients: results from the PAGER study

“…As a complement to the curative treatment of the medical condition, the goal of acute geriatric care (AGC) models is to maintain and enhance patient’s independence in activities of daily living (ADLs) and mobility, and to prevent hospital-acquired functional decline through early mobilization and rehabilitation [ 22 , 23 ]. AGC typically includes a comprehensive geriatric assessment, multidimensional therapeutic strategies tailored to the complex and individual needs of patients, early physical rehabilitation, regular team meetings with all health professionals involved in care processes (i.e., geriatrician, nurse, occupational therapist, physiotherapist, psychologist, social workers), clinician leadership, prepared environment, patient-centered goal setting, and early discharge planning for transition of care [ 22 – 25 ].…”

Optimal dose and type of physical activity to improve functional capacity and minimise adverse events in acutely hospitalised older adults: a systematic review with dose-response network meta-analysis of randomised controlled trials

“…Second, the optimal dosage, which may be physical activity type-dependent, remains unknown. Finally, there is a common perception that physical activity may increase falls and other negative events (fostering the culture of ‘bed rest’ while in hospital) 7 9. Physical activity interventions often report no6 or few adverse events 7.…”