More than one third of people admitted to the hospital are older adults. And at any time, almost half of people in the hospital are 65 or older. Almost half of older adults seen in an emergency department are admitted to the hospital.
When many older adults leave the hospital, they may be in worse shape than before they became ill. Part of the reason for the decline is that older adults tend to have longstanding serious and debilitating disorders when they enter the hospital. (See also Problems Due to Hospitalization.)
However, part of the reason is just being in a hospital, which can cause problems, regardless of age. Older adults are more likely to already have or to develop these problems, and the consequences are more likely to be serious for the following reasons:
Confusion: Changes that occur as people age make them more likely to become suddenly and noticeably confused (have delirium).
Dehydration: Older adults tend to feel thirsty less quickly or less intensely than younger people. They thus are inclined to drink less, especially when circumstances make getting water more difficult, as occurs in a hospital.
Falls: Older adults are more likely to fall and, if they fall, more likely to have a serious injury such as a broken bone.
Incontinence: Older adults may have particular difficulty getting out of a high hospital bed after they have had surgery, when they have a serious disorder, or when they have various equipment attached to them. As a result, they may not get to a toilet in time.
Loss of independence: During a hospital stay, older adults may become unable to take care of themselves because staff members provide this care (such as bathing).
Loss of muscle tissue: When they spend a lot of time in bed or are immobilized, older adults tend to lose more muscle tissue and lose it more quickly.
Pressure sores: Older adults are prone to pressure sores because they tend to have less fat under the skin and blood flow to the skin is decreased. If they develop pressures sores, they may be sent to a nursing home rather than their own home after they are discharged from the hospital.
Side effects of medications: Before entering the hospital, many older adults are taking several medications (see also Aging and Medications). In the hospital, more medications may be prescribed. The more medications people take, the greater the chance for side effects and interactions with other drugs, supplements, or foods. Also, older adults are more sensitive to the effects of certain medications.
Undernutrition: Physical age-related changes may reduce appetite or absorption of nutrients, as may certain disorders (including dental problems) and medications.
Many older adults have difficulty bouncing back psychologically and physically from the experience of being in a hospital as well as from the disorder they have had.
Preventive Strategies
Some hospitals have developed strategies to prevent problems that can result when older adults are hospitalized. These strategies are designed to help older adults continue to function as well as they did before they became ill.
An interdisciplinary team: This team consists of health care professionals who work together to care for an older person. Team members evaluate the person’s needs and coordinate the person’s hospital care. Team members look for possible problems and correct or prevent them.
A one-focus team: This team focuses on preventing and managing one specific problem, such as undernutrition or pressure sores. Such teams are often led by a nurse, who checks the person for the problem and develops a care plan.
Geriatricians: These doctors are trained specifically to care for older adults and can help prevent problems common among them. For example, geriatricians avoid prescribing medications or combinations of medications that are particularly likely to cause problems in older adults and may stop medications that have minimal benefit or potential side effects (see also Aging and Medications).
Guidelines: Hospitals may also follow guidelines for care (protocols) developed specifically for older adults.
An assigned nurse: Sometimes one nurse is assigned to have primary responsibility for and to monitor a person’s care. This nurse makes sure that other staff members understand the treatment plan for the person.
Geriatric nursing units: These units are designed for older adults and staffed with people trained in caring for them. In these units, older adults are encouraged to get out of bed as soon and as much as possible. They are encouraged to dress each morning, to follow their usual daily routine as much as possible, and to eat in a group dining room. If older adults are going to be in the hospital a long time, they are encouraged to personalize their room with photographs, pillows, and other familiar items. Staff members encourage family members and friends to participate in care.
Treatment
How aggressively a disorder is treated in a hospital should not depend on age. Family members and older adults should talk with a doctor to make sure options for treatment are based on the severity of the disorder, not on age. However, less aggressive treatments are sometimes appropriate for older adults, depending on their wishes and outlook—that is, how the disorder is expected to progress and how long they are expected to live. Having advance directives, which state what sort of care people want, is particularly important for older adults.
