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August 15, 2016

Why elderly patients often leave the hospital more disabled than when they arrived

Daily Briefing

Too much bed rest, poor nutrition, and excessive testing can take a toll on elderly patients—but some providers are taking steps to address the issue, Anna Gorman reports for Kaiser Health News.

According to a 2011 study published in JAMA, about one-third of patients over age 70 and one-half of patients over age 85 leave the hospital more disabled than they arrived, even if they have recovered from the original illness or injury that led to their hospitalization.

A special ED for Grandma? Why some hospitals think it's the way of the future

Ken Covinsky, a physician and researcher at the University of California-San Francisco, said that's because hospitals often don't care properly for older patients. Gorman writes that many hospital-related problems that may be "merely annoying" to younger patients, such as sleep deprivation or inadequate nutrition, can cause long-lasting damage in elderly patients.

"The older you are, the worse the hospital is for you," Covinsky said. "Sometimes with the care of older people, less is more."

Taking action

Some hospitals are taking steps to address the issue.

To help seniors leave the hospital sooner, San Francisco General created a ward specifically for elderly patients. Clinicians working in the Acute Care for Elders (ACE) don't focus solely on the diagnosis that brought the patient to the hospital, but also on how to help patients live as independently as possible at home.

For instance, staff remove patients' catheters and IVs as often as possible and encourage patients to leave the bed, move around, and eat in a communal dining area, said Edgar Pierluissi, the ACE unit's medical director. "Bed rest is really, really bad," he said. "It sets off an explosive chain of events that are very detrimental to people's health."

But while specialized wards such as San Francisco General's can help elderly patients, they're fairly rare, and space is limited. Convinsky noted that payers have not asked hospitals to report on whether patients lose their mobility or independence once they leave the hospital, so organizations may not focus as much on those concerns as on metrics that can affect reimbursement. "If you don't measure it, you can't fix it," Convinsky said.

However, Robert Palmer, director of the geriatrics and gerontology center at Eastern Virginia Medical School, told Kaiser Health News that as more payments are tied to quality, investments in elderly patient care will begin to save money down the line for hospitals.

"If you don't feed a patient, if you don't mobilize a patient, you have just made it far more likely they will go to a skilled nursing [facility], and that's expensive," he said (Gorman, Kaiser Health News, 8/9).

Key considerations for developing your geriatrics program

Key considerations for developing your geriatrics program

The United States Census Bureau projects the country's elderly population to double by 2050—and it's time for your geriatrics program to grow along with it.

Health systems report that skilled treatment of geriatric syndromes can increase elderly patients’ satisfaction rates, decrease LOS, reduce readmission rates, increase the length of time between admissions, and reduce costs. Download our Geriatrics Program Cheat Sheet to learn the strategic, financial, and operation concerns for maintaining a successful program.


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