“When Resilience is Not Enough: Finding Our Way to Age-Friendly Hospitals”

Abstract

This discussion features a multidisciplinary panel of providers from two different Arizona hospital systems. Each group will describe what they have done to create innovative approaches to preventing and mitigating hospital-acquired delirium. Drs. Agarwal and Hendrie from Banner University Medical Center, Phoenix, will present their EMR-based delirium detection tool and the Hospital Geriatrician Team response to those patients in their daily rounds. Anna Bourguet and Stephanie Lee from Southern Arizona VA Health Care System in Tucson will describe the creation and use of a Delirium Risk Assessment and Treatment computer-based tool for providers.Delirium, often referred to as toxic-metabolic encephalopathy, is the most common neuropsychiatric syndrome that occurs in the general hospital setting. Incidence can range from 10-30% in general hospital wards, up to 87% in ICU settings, up to 46% in surgical wards. Older adults are at higher risk for delirium than other age groups, and in 10-35% delirium is already present at hospital admission. Patients who meet criteria for “frail elderly” may have up to 60% incidence of delirium, regardless of their medical condition.Delirium vastly increases hospital costs ($152 billion annually has been reported), length of stay, and other medical morbidities. Post-delirium, risk of death is increased at time of discharge and even one year later. Risk of post-delirium institutionalization is increased. Another complication is less well known is permanent cognitive impairment. There is a reciprocal relation between delirium and dementia: dementia does lower the threshold for developing delirium, and after delirium there is an acceleration of cognitive decline. Treatment of delirium is largely via nonpharmacologic mitigation approaches, there are no FDA approved medications to treat this condition. The moderator of the session will describe the clinical syndrome of delirium, its prevalence and outcomes. In addition, the Hospital Elder Life program as well as ICU treatment strategies will be presented. We will describe the concept of Age-Friendly Hospitals and how they are used around the world.