From Research to Reality: Minimizing the Effects of Hospitalization on Older Adults

Abstract

This review examines ways to decrease preventable effects of hospitalization on older adults in acute care medical (non-geriatric) units, with a focus on the Israeli experience at the Rambam Health Care Campus, a large tertiary care hospital in northern Israel. Hospitalization of older adults is often followed by an irreversible decline in functional status affecting their quality of life and well-being after discharge. Functional decline is often related to avoidable effects of in-hospital procedures not caused by the patient’s acute disease. In this article we review the literature relating to the recognized effects of hospitalization on older adults, pre-hospitalization risk factors, and intervention models for hospitalized older adults. In addition, this article describes an Israeli comprehensive research study, the Hospitalization Process Effects on Functional Outcomes and Recovery (HoPE-FOR), and outlines the design of a combined intervention model being implemented at the Rambam Health Care Campus. The majority of the reviewed studies identified preadmission personal risk factors and psychosocial risk factors. In-hospital restricted mobility, under-nutrition care, over-use of continence devices, polypharmacy, and environmental factors were also identified as avoidable processes. Israeli research supported the findings that preadmission risk factors together with in-hospital processes account for functional decline. Different models of care have been developed to maintain functional status. Much can be achieved by interdisciplinary teams oriented to the needs of hospitalized elderly in making an impact on hospital processes and continuity of care. It is the responsibility of health care policy-makers, managers, clinicians, and researchers to pursue effective interventions to reduce preventable hospitalization-associated disability.

Priority nursing foci and interventions for older people in acute care settings

“…However, although informing is perceived as an important intervention, it is not implemented very often, which may compromise the involvement of informal caregivers. According to Admi et al (2015), the involvement of informal caregivers is a key psychosocial risk factor in the health/illness transition process. Furthermore, nurses have consistent perceptions of the interventions observing and managing, and different perceptions of performing, attending, and informing.…”

“…Osuna-Pozo, Ortiz-Alonso, Vidán, Ferreira, and Serra-Rexach (2013) have reported that older people's main risk factors for FD associated with hospitalization are advanced age, lack of mobility, cognitive changes, and functional status prior to hospitalization. Recent studies conducted with older inpatients in acute care settings (medicine and surgery units) found an increase of FD in ADLs and IADLs when comparing FC before admission, during hospitalization, and after clinical discharge (Cação, 2017 Admi et al, 2015). According to the same authors, the involvement of informal caregivers during hospitalization may be essential.…”

“…The existing evidence has identified some risk factors for FD related to hospitalization: demographic factors, cognitive and psychological status, functional status before hospitalization, social factors, comorbidity and polypharmacy, mobility, nutritional status, sensory deficits, and geriatric syndromes (Lafont, Gérard, Voisin, Pahor, & Vellas, 2011). According to Admi, Shadmi, Baruch, and Zisberg (2015), there are several risk factors for FD during hospitalization, namely personal and psychosocial risk factors, as well as factors related to acute care settings. The most commonly reported personal risk factors include age, low activity of daily living (ADL) or instrumental activity of daily living (IADL), and nutritional status (Hoogerduijn et al, 2012).…”

Translation and content validation of the Geriatric Institutional Assessment Profile for Brazil

“…At the time, they represented 16.11% of the population and contributed to 27.85% of hospitalizations, and to 36.47% of the resources paid for them (2) . In addition, hospitalized older adults suffer significant reduction in functionality and often receive discharge with inferior capacity compared to the functional condition of admission (3) .…”

Nurses' Experience With and Perception of Barriers to Promoting Mobility in Hospitalized Older Adults: A Descriptive Study

“…I nsufficient mobility is a significant contributor to hospitalacquired functional decline in older adults (Admi, Shadmi, Baruch, & Zisberg, 2015;Brown, Redden, Flood, & Allman, 2009;Cadogan & D'Ambruoso, 2012). Hospitalacquired functional decline is alarming because escalating rates of hospitalization can be expected in the near future as the number of older adults in the United States is predicted to increase to more than 70 million by 2030 (Administration on Aging, 2012).…”