Assessing Risks Associated with Hospitalization in Elders

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Summary and Comment

Assessing Risks Associated with Hospitalization in Elders

Internal medicine residents often are not aware of their older patients’ risks for adverse outcomes during hospitalization.

Hospitalized elders are at risk for many iatrogenic complications, including delirium, malnutrition, pressure ulcers, falls, depression, infection, and adverse drug events. These complications often are referred to as "hazards of hospitalization" and can result in marked functional decline, additional medical or surgical interventions, prolonged length of stay, placement in extended-care facilities, or even death. Such complications also substantially increase the cost of medical care and negatively affect patient and family satisfaction. Although interdisciplinary teamwork is required to allay potential harm from hazards of hospitalization, modifying patient risk factors invariably requires physician intervention.

A cross-sectional study was performed among house staff and patients from four medical units at Mount Sinai Medical Center. Eighty-six teams of one intern and one second- or third-year resident completed 23-question surveys on three of their recently admitted patients. Within 2 hours of survey completion, the study investigator interviewed eligible patients (i.e., age, $≥$ 65) and, if appropriate, their surrogates. Discrepancies between house staff responses and patient and surrogate responses suggested that house staff were largely unaware that many of their patients had substantial risk factors (including patients’ orientation to place and duration of hospitalization; quality of sleep; pain; history of falls; mood; food intake; and use of hearing aids, glasses, or ambulation devices) for hazards of hospitalization.

Comment: Although this study is simply observational, its results do highlight the need for better recognition of risk factors that can adversely affect older hospitalized patients. Training of healthcare providers as teams is a critical strategy for identifying risks for hazards of hospitalization and implementing appropriate interventions. Hospitalists are at the forefront of the patient-safety movement and, as role models, can be powerful motivators of behavioral change.

— Sylvia C.W. McKean, MD, FACP

Published in Journal Watch Hospital Medicine March 17, 2008