Ten ways to improve the care of elderly patients in the hospital

Abstract

Hospitalists care for elderly patients daily, but few have specialized training in geriatric medicine. Elderly patients, and in particular the very old and the frail elderly, are at high risk of functional decline and iatrogenic complications during hospitalization. Other challenges in caring for this patient population include dosing medications safely, preventing delirium and accidental falls, and providing adequate pain control. Ways to improve the care of the hospitalized elderly patient include the following: screening for geriatric syndromes such as delirium, assessing functional status and maintaining mobility, and implementation of interventions that have been shown to prevent delirium, accidental falls, and acute functional decline in the hospital. This article addresses these issues with 10 evidence‐based pearls developed to help hospitalists provide optimal care for this expanding population. Journal of Hospital Medicine 2011;6:351–357. © 2011 Society of Hospital Medicine

Falling behind: a substantive theory of care for older people with cognitive impairment in acute settings

“…Previous studies have recommended formal assessment of cognition when older patients are admitted to hospital to facilitate adequate care and to avoid complications (Maslow & Mezey , Labella et al . ). Not identifying signs and symptoms of dementia or delirium have been shown to hinder early diagnosis, medication and other management strategies that can minimise suffering (Borbasi et al .…”

“…, Labella et al . ). The hospital stay can also be a stressful and threatening experience for people with cognitive impairment because it often means sharing space with strangers, being in an unfamiliar setting and having one's private space invaded (Edvardsson & Nordvall ).…”

‘Are decisions about discharge of elderly hospital patients mainly about freeing blocked beds?’ A qualitative observational study

“…However, a factor that complicates the care of frail elderly patients who have multiple needs is the traditional focus of hospital wards on only one or a few medical conditions; 12 13 and a lack of access to multidisciplinary teams that can meet the complex needs of frail elderly patients. This means that, although frail elderly patients and geriatric syndromes are common in hospitals, [12][13][14] the hospitals do not focus on taking care of them and they are sometimes perceived as not fitting in by the healthcare staff. 15 Earlier studies on the participation of elderly patients in decision-making in hospital wards have led to a deeper understanding of participation and what it means to these patients.…”

Hospital morbidity among elderly in the region of Sfax, Tunisia: Epidemiological profile and chronological trends between 2003 and 2015

“…In the same way, considering the specificity of their pathologies, the prevention must occupy an important place in the management of these aged people: better nutrition, good hydration, vaccination against the flu, adequate physical and social environment as well as an adequate management in case of hospitalization. 30 In Tunisia, the rapid process of development has brought about demographic and epidemiologic changes. Consequently, the proportion of the elderly has been increasing.…”