As you may know, hospitalization is actually somewhat risky for older adults.
This is sometimes surprising to older adults and families. After all, hospitals are supposed to be places where people who are ill or injured can get the medical supervision and services that they need, to recover and be restored to health.
Well, it’s certainly true that hospitalization is often the only way for a person to obtain more substantial care from nurses and doctors. (There actually is an alternative called Hospital at Home, but it’s not widely available.)
If you’ve broken a hip, or have developed really significant shortness of breath from pneumonia, or otherwise are too unwell to be safely treated in the outpatient setting, hospitalization is often necessary. And since aging increases one’s vulnerability to a variety of health problems, older adults get hospitalized at higher rates than younger people do.
The problem, however, is that although hospitalization is intended to help patients, we’ve also realized that it tends to stress the body and mind in many ways. This is hard on every patient, but especially affects older adults. For instance:
- Most people find it hard to sleep well in hospitals, in part because they are noisy and also staff may come in to check blood pressure, or draw blood during the night or early morning. This means many patients are sleep-deprived, which can interfere with convalescing, or worse yet, provoke delirium.
- Delirium is very common in hospitalized older adults. This state of “worse than usual” mental function is very common after surgery, but also can be brought on due to the stress of medical illness and other factors. (Learn more here: Hospital Delirium.)
- Lying in bed means that all patients start to lose strength. As one ages, this loss of strength and mobility happens even faster. So, many older adults can experience significant losses in strength and mobility during a hospital stay.
It’s no secret within healthcare that hospitalization is risky for older adults, and we’ve actually understood the reasons why for quite some time.
But until recently, hospitals didn’t seem to have the right incentives and support in making needed changes.
Fortunately, that is now changing, with the growth of the Age-Friendly Health Systems movement.
Creating Age-Friendly Hospital Programs
In a recent podcast episode, I interviewed UCSF geriatrician Dr. Stephanie Rogers, who has been applying the principles of Age-Friendly Health systems to create new inpatient geriatrics programs at UCSF Hospital.
Specifically, over the past few years, Dr. Rogers and her colleagues have launched:
- An Acute Care for Elders Unit
- This is a special hospital ward, designed to help older adults avoid many common complications of hospitalization, such as loss of mobility, loss of independence, falls, malnutrition, delirium, risky medications.
- A Hip-Fracture Co-Management Service
- Experts in geriatrics and orthopedics created a “best-practices” pathway for hip fracture, which is designed to minimize hospital risks and maximize the older person’s chance of returning to function. (Such “best-practices pathways” are important, because otherwise healthcare tends to be variable and it’s common for patients to not get whatever care is currently recommended as optimal.)
- Every patient admitted with a hip fracture now gets seen by a geriatrician working in partnership with the orthopedics team.
- A Delirium Reduction Campaign
- UCSF is now screening all patients for delirium, and has trained staff in prevention and management.
All three of these programs are fantastic and are making UCSF’s hospital care much better and safer for older adults.
To learn more about them, and about Age-Friendly Health Systems, I highly recommend listening to the podcast interview with Dr. Rogers:
086 – Interview: Creating Age-Friendly Health Systems at UCSF
You can also download a transcript of the interview here:
Transcript: Creating Age-Friendly Health Systems at UCSF
Why Everyone Should Learn About UCSF’s New Age-Friendly Programs
If you don’t live in the Bay Area, do you need to know about these new programs at UCSF?
Yes! Here’s why.
First of all, whether similar programs are available at your hospital or not, it’s always a good idea to learn more about the risks of hospitalization in aging, and how they can be countered.
Far too many older adults and families are blindsided by common problems related to hospitalization, such as delirium or loss of strength and independence.
I don’t want people to be overly anxious about the risks of hospitalizations, but I do think it’s important to be informed, as this enables people to consider being proactive.
Next, if you want your local hospital to become more “age-friendly”, it will help if they hear that from you!
So if you’re an older adult, or concerned about an older relative, or in any way interested in how we can make healthcare better for older adults, I hope you’ll take advantage of the recent podcast episode.
The sooner we all learn more about Age-Friendly Health Systems, the sooner we’ll reach a point at which getting better and safer care becomes the norm for older adults, rather than the exception.
086 – Interview: Creating Age-Friendly Health Systems at UCSF
Transcript: Creating Age-Friendly Health Systems at UCSF
Questions about better and safer hospital care for older adults? Or about Age-Friendly Health Systems? Post them below!
Amy Asch says
What a marvelous development. I want to recommend that the hospitals near my parents (in NJ) look into this, but I don’t know who/how to approach. Dr. K — can you suggest a job title or department I should contact?
Leslie Kernisan, MD MPH says
Hm, good question! I’m not sure who would be best to contact. You could see if there is something similar to a patient relations department? And you could ask if they have any patient/family councils. I also think it can’t hurt to write a letter to the hospital’s CEO.
Regan Chandler nelson says
I had knee replacement surgery in April. I was not myself for five days and didn’t know what was going on. I realize now I had a post operative delirium. I couldn’t walk. The surgeon told my husband that he thought I just didn’t want to get stronger or heal. I had to go to a convalescent home. They would not let me out of my bed without a staff member and they were always too busy to help me. I did not get the post operative walking I so badly need it. After three days I had a panic attack I knew I had to get out of there. I came home after a week in the facility. Now I’m having trouble walking.
My balance is off and my body can’t do movements it could before I went in the hospital. I am doing physical therapy exercises and walking at home, and going to a pool at the gym three times a week I could walk before I went in. I am wondering if the post operative delirium and cognitive dysfunction are causing the issue. And hoping that this will resolve it self. Oh yes and I’m scared and so discouraged.
Leslie Kernisan, MD MPH says
Sorry to hear that you’ve been having a more challenging recovery. If you are still having difficulty with balance and movement, I would definitely bring it up with your health care providers. You could also consider consulting with a neurologist.
I know to have such a change in health can be very scary and discouraging. And, do what you can to learn to cope constructively with the anxiety and worry, because on it’s own, it’s not good for one’s health and body. Certain types of psychotherapy can help. Some people also find calming hypnosis audios helpful. It can help if you’re able to put your mind and body in a state that promotes healing, recovery, acceptance. Obviously, it’s easier said than done, but it’s worth trying for.
Good luck!
Brenda kelly says
I would like to know about older people in hospitals that would care for older adults to have a different care and at what hospitals.
Leslie Kernisan, MD MPH says
Thank you for your interest in older adults and hospital care. I’m afraid I don’t quite understand what your question is. If you are trying to find age-friendly hospital programs near you, I would recommend calling your local hospitals and asking them if they are familiar with the age-friendly healthcare movement. You could also ask if they have an Acute Care for Elders (ACE) unit, or offer any special delirium prevention and screening programs.
PG says
Two years ago, my husband, aged 77 at the time and post several surgeries some 14 years earlier for noncancerous overgrowth of the prostate gland, had pneumonia and suffered a collapsed lung. He had surgery by a thoracic surgeon who reversed the collapsed lung. However, prior to the surgery he was given a medication to keep him from urinating during the surgery, and after the surgery he lost the ability to urinate. He had a catheter for two years in his penis and took medications and had acupuncture but did not regain his ability to urinate. Last summer he had surgery for GERD and a hiatal hernia, by the same thoracic surgeon, which was also successful. At the same time he had a suprapubic catheter inserted by another surgeon. He finds the suprapubic catheter uncomfortable and he is ashamed of it. Three questions: (1) does the drug he was given to keep from urinating during surgery cause the patient to lose the ability to urinate or could that be a result of anesthestics? (2) is there anything that can be done now to regain the ability to urinate? and (3) is there any way to avoid taking the anti-urinating drug before surgery? Thank you.
Leslie Kernisan, MD MPH says
Sorry to hear about what happened to your husband, sounds very difficult.
I mostly work in the outpatient setting, so honestly I’m not sure what drug he was given prior to surgery. In general, it sounds like he has a complicated urological situation.
I would recommend consulting with a urologist regarding your questions. I have had patients who must regularly “straight cath” themselves 2-3x/day, but I don’t know if this would be an option as an alternate to his current suprapubic catheter, and I don’t know how common it is for someone like him to resume urinating after 2 years.
Presumably, your husband has already seen a urologist given all these procedures, but sometimes it can be very valuable to get a second opinion, perhaps from someone at a major academic medical center. Several major medical centers also offer a remote “second opinion” service, such as this one at UCSF: https://www.ucsfhealth.org/secondopinion/
Good luck!
Heather Jones says
I guess it depends what hospital you go to and what country you live in… Here in Victoria, B.C. Canada they keep the elderly mobile and have them go to rehab until they are ready to go home.. they also have a system where the home is checked out to make sure that the home is ready for them.. bars on the walls in the bathroom, etc…
But… what we need in Victoria is better information gathering when an elderly person arrives at the hospital… Years ago, my mother had a stroke and fell to the floor. She got up again and then fell again. My Dad called 911 and told the paramedics that he felt that Mom had a stroke… Mom lost the ability to walk, sit properly and use her left arm.. Her pupils were a different size from each other and her speech wasn’t normal… Mom was diagnosed with diabetes in the hospital but our family kept asking about what seemed to us a being a stroke… they just looked at us like we didn’t know what we were talking about until about 4 days later a nurse asked us how we cared for Mom at home and we said… we didn’t have to care for her at home. Mom could walk on her own, make dinners etc… Then Mom had another stroke in the hospital and a Neurologist looked at her. He told us she could pass away any day or live up to about 6 months as she has had a stroke and will likely keep having them… but he got Mom onto Statin drugs and she improved and is still alive today after having to re-learn how to sit up, walk, dress herself….. If this is what can happen to an elderly person who has a whole family around her to support her…. I’d hate to think of what happens to people with no supportive family or friends around…. This was over 7 years ago. Mom is still alive and walking..
Sincerely…. Heather
Leslie Kernisan, MD MPH says
Thanks for sharing your story. Wonderful that your mother was able to recover from her hospitalizations.
Agree that it’s essential to get the right information from the patient and family and medical record at the start of the hospitalization. We need to work on this in the US too!
netmouser says
As someone suggested to me. Many patients do not have adequate help to oversee their care. Especially for anyone alone or senior, ask the hospital chaplin to be your patient advocate, check in on you and watch over your care. You certainly need not be religious.
Leslie Kernisan, MD MPH says
Thanks for this suggestion. I’ve never heard of someone requesting the chaplain to help with advocacy, but it can’t hurt to ask. Some hospitals also have volunteers available to assist patients in various ways.