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The nearly 25% of adults 65 years and older who are hospitalized each year represents a higher proportion than for any other age group. Many of these older adults experience protracted or permanent functional decline and worsening health after their acute hospital stay. Although people 65 years and older comprise only about 12% of the U.S. population, they account for one-third of acute hospital admissions and about 46% of the national costs for acute hospital care.

National data show that older hospitalized patients have a more complex hospital course than younger hospitalized patients (Table 17-1). In 2003, the length of stay for patients 65 years and older was 1.7 days longer than for those under 65 years old, although the length of stay for the major discharge diagnoses has dropped since 1997. The mean total hospital costs were 46% higher for the 65 years and older group compared with the younger group. Hospital costs for older patients have increased over 25% since 1997. Although hospital deaths are decreasing, people 65 years and older have nearly five times the in-hospital mortality as younger hospitalized patients.

Table 17-1 Characteristics of Hospitalizations Among Nonelderly and Elderly Populations, 2003

While many principles of acute hospital care are the same for all age groups, the elderly patient population is at increased risk of collecting comorbidities and accompanying medications, functional decline, cognitive impairment, and dwindling social supports. Therefore, there are several issues related to the hospital admission, hospital stay, and discharge that deserve specific attention when considering the care of the geriatric population. The care of hospitalized elders requires a systematic approach to the evaluation and management of commonly seen geriatric conditions and perhaps implementation of structural changes specifically designed to address the needs of this often medically complex and potentially vulnerable population.

Reasons for Admission for Geriatric Patients

The major diagnoses for which older adults are hospitalized are related to chronic diseases and respiratory conditions. The 15 most common conditions, accounting for 48% of the hospital admission diagnoses, are listed in Table 17-2. Also common and important to recognize, but less likely to be reported as the reason for admission, are conditions more likely to occur in older adults such as failure to thrive, falls, adverse drug effects, or change in mental status. In addition, older adults maybe admitted with an atypical presentation of another condition, such as when change in mental status is due ...

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