Strategies that can improve how older patients fare after being in the hospital

Being hospitalized can have a significant, ongoing impact on the health of older patients. Even when the treatment of the illness or injury that brought them to the hospital is successful, many older patients leave the hospital physically weaker, with cognitive issues like confusion, or with psychological issues like depression and anxiety that can have a lasting negative effect on both their health and quality of life. One study found that approximately 20% of older patients discharged from the hospital are readmitted within 30 days. Another discovered that nearly a third of patients over 70 and half of those older than 85 left the hospital more disabled than when they were admitted and now needed help with daily activities.

There are strategies, however, that can lower the risks of readmission and ongoing health problems by proactively dealing with the underlying causes of these problems. A growing number of hospitals are changing their approach to treating older patients to improve how patients fare after they’re discharged by creating special Acute Care for Elders (ACE) units. These units are designed to meet the unique needs of patients 65 and older. The healthcare team includes geriatric specialists, nursing staff, and social workers who build a plan to help patients get back home and live as independently as possible. A health advisor can help you find hospitals that have an ACE unit or practice the principles of care that these units follow.

What do older patients need to do better after being hospitalized?

Doing better after being in the hospital actually starts with what happens while older patients are in the hospital:

• Patients need to move around. Some studies have found that older patients spend just 43 minutes a day standing or walking. But when they spend days or even weeks in bed, their strength, coordination, and confidence can deteriorate quickly. Being immobile can also increase the risk of complications such as blood clots, pressure sores, and confusion. To mitigate those risks, it’s better for patients to be able to move around every day. Even walking around the room or down the hall with the supervision and support of a nurse or physical therapist several times a day can make a difference. Some hospitals offer specially modified, low-intensity exercise classes to give older patients the chance to both move and socialize.
• Patients need good quality sleep. Late night checks on vital signs and noisy units can disrupt patients’ sleeping patterns. Not getting enough sleep or getting poor quality sleep can in turn increase the patient’s risk of developing delirium. Ask your physician or nurse if it’s possible to limit night-time checks. A white noise machine can also mask some of the noises from the hallway that can make it difficult to sleep soundly.
• Patients need good nutrition. Many older patients don’t eat enough when they’re in the hospital. Some don’t like the food provided, while others are too weak or confused to properly feed themselves. To ensure older patients get the nutrition they need to rebuild their strength during recovery, some hospitals bring patients together in a communal dining area, where a more social setting may encourage them to eat more. For patients who are weak or confused, some hospitals have a nurse or other geriatric specialists work with the patients one-on-one to help them relearn how to feed themselves.
• Patients need a medication review. Older patients frequently take multiple medications prescribed by several doctors to manage chronic health problems. While they’re in the hospital, new medications are often added. To ensure that the medications won’t cause interactions and that they are all needed and appropriate for the patient, the patient’s doctor or a pharmacist should review all the medications, dosages, potential interactions, and side effects. A carefully reviewed, comprehensive curated medical record can also be a valuable tool to lower the risk medication errors and interactions.

It’s also important that the patient, family and other caregivers understand what to do after the patient is discharged from the hospital, including whether there are medications they need to discontinue after a certain period, when they need to make a follow-up appointment, and what the next steps in the treatment plan are.