Elderly patients who are hospitalized run a significant risk of functional decline. In a special supplement to The Hospitalist, “Caring for the Hospitalized Elderly“, the authors point to well-documented risks for elders of hospital complications, such as falls with possible fractures,
delirium, nosocomial infections, medication interactions, and surgical complications. In addition, any elderly person, particularly a frail elderly person, put to bed for even a few days suffers a great risk of deconditioning and loss of functioning.
Especially concerning is the issue of hospital delirium, which is a particular risk for individuals who are already showing some cognitive decline or have a diagnosis of some form of dementia. Each year 20 percent of the 11.8 million elderly patients in hospitals develop delirium and though symptoms generally reverse, there is increasing evidence that delirium may lead to long-term cognitive impacts.
Seniors suffer about a 23% risk of being unable to return home/requiring nursing home placement, simply by losing functioning in activities of daily living from even a short hospitalization. There are many programs at work to improve outcomes for elders in the hospital, by working on precautions in the hospital as well as transition gaps.
Transitions have been a big focus for many in the healthcare arena, in attempts to improve the well-documented level of readmissions risk that elders suffer. Starting on October 1st, Medicare made some major payment changes targeting readmissions through financial penalties.
Elders (65 and older) account for almost 50% of inpatient days of care in the U.S. and elders over age 85 have about twice the rate of hospitalization as those aged 65 to 74. The acute care of a hospital setting is often needed to manage the complex medical needs of someone with multiple conditions. However, one important tip we offer to caregivers is to work closely with providers on managing conditions outside of the hospital and care planning proactively. Closely monitor symptoms and discuss preventative care. Consider getting a geriatric assessment in order to determine important areas to be monitored, create a comprehensive care plan and identify risk areas and resources to help. Find out about advanced care planning and discuss options with your healthcare providers. Can certain conditions be treated outside of a hospital setting? What type of care and treatment does your loved one want based on prognosis, quality of life and other factors? Should care be put in to place that may help reduce risks (such as medication management, falls prevention, safety assistace with daily activities of daily living)?
When a loved one needs hospital care, there are some things you can do that may help mitigate the risks:
- Consider hiring hospital sitters or rotating family members to stay in shifts with your elder loved one. Sitters can play an important role in safety and observing changes to assist medical providers.
- Talk to your medical providers and hospital staff about geriatric precautions and any special concerns related to your loved one. Has Dad gotten confused and agitated on a previous hospitalization? Does Mom tend to have difficulty with certain medications or anesthesia? Is Grandma hard-of-hearing but doesn’t speak up if she does not understand something?
- Provide good information to providers. Keep detailed records and provide information about your loved one’s condition, medications, and history. Make sure medical providers have your information and understand your role in your loved one’s care (provide your legal documentation such as healthcare surrogate/power of attorney and have your loved one complete their privacy permission forms as applicable).
- Note any symptoms or changes and report them to the hospital staff. If your loved one is showing confusion or an altered state of consciousness, you may be noticing the signs of delirium. Ask questions if you are wondering if a symptom is typical. You are not only your loved one’s best advocate, but a great source of information to assist medical providers in the best treatment plan.
As mentioned, when it comes to seniors and hospitalization, transitions are a key area of trouble. About 1 in 5 Medicare patients gets readmitted to the hospital within 30 days of being discharged.
Of course, there are many factors that affect this figure and some readmissions will always occur due to complications that occur with complex medical care. However, a lot of research has indicated that certain gaps in care and communication are creating “avoidable” readmissions. This is what Medicare is attempting to target, with financial penalties for hospitals with high readmissions rates.
The studies on readmissions have uncovered some of they key areas where gaps and concerns arise. Programs to reduce readmissions have been successful when addressing some of these key factors. This information can also be valuable for families. Here are some of the key areas that you can make sure to address in the discharge process for your loved one:
- Medication reconciliation: medications are often changed during a hospitalization. This may lead to various complications, from side effects to overlapping medications (your loved one does not realize a new medication replaces an old one and continues taking both) or improperly taking medications. Your loved one may have been doing well managing the medication regime prior to the changes, but may now need coaching on current medications, a review and teaching session or even ongoing medication assistance.
- Communication/coordination issues: the “handoff” period from the hospital to community seems to be fraught with miscommunication and gaps at times. Simple, clear discharge instructions (explained to the patient and caregiver, but also put in writing) along with planning initial follow-up visits have been proven to help significantly. As a caregiver, make sure you get instructions on follow up and what to watch for in the days proceeding the hospitalization. Print out a copy of our discharge planning checklist for when a senior is going home from the hospital to help you.
- Extra assistance for the follow-up period: as mentioned, many seniors suffer a functional decline and deconditioning while in the hospital and this can lead to safety issues while recuperating. Consider help during these transitions, especially on the day of discharge when other services might not yet be in place. You can always cancel or reduce services as your loved one gets stronger, but many patients and families find themselves overwhelmed when first arriving home.
Certain medical issues inevitably will need to be treated at the hospital. As a caregiver, it is vital that you be aware of some of the issues that might arise for an elder who is hospitalized. As your loved one’s advocate, you can contribute to better care outcomes by taking some of the steps we have mentioned.
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EasyLiving offers post-hospital senior care help ranging from a "First 24 hours" program to customized home care assistance and medication management. We also offer geriatric care management and consulting services to help you with transitions of care, paying for care/resources, guidance about assisted living options and more.