Preventable Hospitalizations in Older Adults: A Dream or Reality?

Abstract

An 84-year-old male patient applied to a primary care clinic with the complaint of left hip pain. The patient was diagnosed with myalgia and was given nonsteroidal anti-inflammatory drug (NSAID) (dexketoprofen) and muscle relaxant (feniramidol). After 1 week, the patient was brought to the emergency service due to anorexia and nausea by his relatives. He had been continuously using escitalopram 10 mg and rivastigmine patch 10 cm 2 for depression and dementia comorbidities. According to the laboratory investigations, it was seen that serum creatinine was 2.53 mg/dL (1.07 mg/dL 3 months ago), urea was 89 mg/dL (30 mg/dL 3 months ago), and potassium was 6.02 mg/dL (3.79 mg/dL 3 months ago). The patient was hospitalized with the diagnosis of acute renal failure and dehydration. Sample Case-2A 78-year-old female patient applied to the emergency care unit with the complaints of fever, cough, and respiratory disorder. It was found out that the patient had chronic obstructive pulmonary disease (COPD) and hypertension in her history. In physical examination, O 2 saturation was found to be 86%, arterial blood pressure was 95/55 mmHg, respiratory rate was 32/min, and there was a decrease in the respiratory sounds in the right lower lung zone. After the posteroanterior chest X-ray showed an infiltration zone on the right, the patient was hospitalized with the diagnosis of pneumonia and intravenous antibiotic therapy was started. On the second day of hospitalization, the patient had a complaint about chest pain. Clinical, laboratory, and electrocardiography (ECG) examinations were performed at the first evaluation. Following these examinations, cardiac catheterization was decided to be applied. A few days after cardiac catheterization, delirium developed in the patient with the symptoms of sudden loss of consciousness, attention disorder, and hyperactivity. The patient fell off the bed on the eighth day of hospitalization when she was in the delirium state and an intertrochanteric fracture developed in the right hip. The patient was transferred to the orthopedic clinic. After the preparation for surgery, a partial hip prosthesis replacement was performed in the patient. The Key Points• "Potentially preventable hospitalizations" are unnecessary hospitalizations despite the possibility of outpatient treatment.• Frail and old people with multiple chronic conditions are under high risk for hospitalization.• These hospitalizations put a heavy burden on the country's economy.• Heart failure, COPD, pneumonia, urinary infections, and dehydration are the most common causes.• To prevent these hospitalizations, interdisciplinary team work, discharge planning, support for drug use, and residential care are needed.Preventable Hospitalizations in Older Adults: A Dream or Reality?Preventable hospitalization is defined as hospitalization of patients in healthy conditions with the possibility of treatment by outpatient care. Preventable hospitalizations are seen commonly in patients aged 65 years or older. Congestive heart failure and chroni...

Prevalence of and Risk Factors for Drug-Related Readmissions in Older Adults: A Systematic Review and Meta-Analysis

“…Pharmacist-led interventions during hospital stay, discharge and post-discharge may reduce potentially inappropriate medication use and ADEs. Interventions that have been studied in the past include improved discharge planning, medication reconciliation and patient education, a medication care plan on discharge and follow-up monitoring by a pharmacist [ 44 – 47 ].…”