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This chapter addresses the following Geriatric Fellowship Curriculum Milestones: #14, #2, #24, #27, #29, #30, #31, #41, #42, #71
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Learning Objectives
The reader will recognize advanced age as a risk factor for hospitalization and for hospital complications.
The reader will understand the importance of a broad assessment of the hospitalized older patient, including medical comorbidities, functional status, cognitive status, caregiver and social support, living situation, and financial resources.
The reader will be able to recognize and take measures to prevent common hospital problems in older patients, including delirium, immobility, falls, malnutrition, pressure ulcers, and nosocomial infections.
The reader will understand the role of palliative and end-of-life care in the hospital care of elders.
The reader will understand the key components of an effective hospital discharge, including thorough patient and caregiver education, robust communication with follow-up physicians, accurate medication reconciliation, an appropriate discharge level-of-care, and timely postdischarge follow-up.
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Key Clinical Points
Older patients are more likely to be hospitalized than their younger counterparts, and more likely to have complicated hospital courses.
Effective hospital management of an older adult requires an understanding of the patient’s comorbidities, functional status, cognitive status, caregiver and social support, living situation, and financial resources.
In addition to treating the patient’s principle problem, hospital providers must also be able to recognize and prevent problems that are common in the older population, including delirium, immobility, falls, malnutrition, pressure ulcers, and nosocomial infections.
The acute hospital care of elders often includes end-of-life care and palliative care.
The hospital discharge is a complex transition of care which depends on several key components, including thorough patient and caregiver education, robust communication with follow-up physicians, accurate medication reconciliation, an appropriate discharge level-of-care, and timely postdischarge follow-up.
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In 2003, patients who were 65 years or older accounted for one-third of all hospitalizations in the United States, despite representing only 12% of the population. According to the 2010 National Hospital Discharge Survey, an estimated 39% of the 35 million discharges from US nonfederal, short-stay hospitals involved patients 65 years or older. Perhaps even more impressive is the continued growth of this aging population. It is projected that, by 2030, one in five Americans will be 65 years or older. At the same time, the very old population (75 years or older) also continues to grow. A patient aged 85 or older is more than twice as likely to be admitted to the hospital as a patient aged between 65 and 74. Older patients are not only more likely to be admitted to the hospital, they also experience a greater number of complications, a longer length of stay, and a higher mortality rate than younger people (Table 16-1).
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