Hazards of Hospitalization

Abstract

Hospitalizations can be potentially hazardous for older patients, even once the acute medical issue or complication that led to the admission is resolved. Special considerations should be taken for the care of elders in the hospital, especially those with advanced age, baseline cognitive impairment, functional limitations, or frailty. While older adults make up 13% of the population, they account for nearly 40% of hospitalizations (Boyd et al. J Am Geriatr Soc. 56(12):2171–2179, 2008; Landefeld. Hospital care. Current Geriatric Diagnosis & Treatment. Lange Medical Books. 2004). They are three times as more likely to require hospital admission as compared to younger adults with similar presentations and, once admitted, typically have longer lengths of stay. Older hospitalized adults tend to have more complex medical comorbidities, greater illness severity, and limited cognitive and functional reserves to overcome the stress of an acute illness and a hospitalization. Vulnerable older adults are at greater risk for decline in healthcare quality of life after an acute hospitalization. Hospitalization for older adults is associated with greater morbidity and mortality, as the severity of illness is often greater. More than 80% of deaths in hospitals are accounted for by older adults. For those patients that are discharged, nearly 25–30% of these patients are rehospitalized due to preventable complications; 49% of patients experience at least one medical error, and close to 20% of older patients discharged from the hospital suffer an adverse event. While the hospital has been seen as the traditional model for the delivery of acute medical care, it is not an ideal care environment for many patients. Older adults are at greater risk for hazards of hospitalizations including iatrogenic events such as nosocomial infections, pressure sores, delirium, functional decline, medication side effects, physical and pharmacologic restraints, and complicated care transitions. While hospitalization in this population is often necessary, it is difficult to ignore the major risk this entails for the patients. Many elderly patients are susceptible to other complications not directly related to the illness or injury for which they were hospitalized or the specific treatment of the problem.