We’ve all heard stories about stories about relatively healthy seniors who break a bone or develop pneumonia, spiral downward, and lose their independence, or worse. Sadly, in some cases, senior patients die after seemingly minor injuries and illnesses. Unfortunately, seniors’ health is at risk both during and after hospital stays. What causes a rapid decline in health? What can you do to minimize the risks for seniors in the hospital? How can you find the best hospital for seniors in your area?
There are many risks for seniors in the hospital.
Although we all go to the hospital hoping and expecting to get better, hospitals can pose dangers for all patients, particularly for seniors. Below find some of the common risks for seniors in the hospital.
Seniors are susceptible to adverse drug reactions.
Adverse drug reactions (ADRs) occur when a patient has an unexpected or dangerous reaction to a medication. ADRs can occur after a single dose of medication, from the prolonged use of a drug, or when there is a negative interaction between 2 or more medications.
Although patients of all ages can experience an ADR, seniors are more susceptible.
Why? Firstly, advancing age changes the way the body processes drugs. Secondly, seniors take a lot of medications. In fact, about 44% of men and 57% of women over 65 take five or more medications (prescription and nonprescription) each week. Moreover, 12% of people over 65 take ten or more medications each week.
Fortunately, experts believe improved communication among providers, and between providers and patients, including improved medication reconciliation during transitions in care can prevent many adverse drug reactions in seniors.
For more information, read What’s an Adverse Drug Reaction? and Medication Errors in Hospitals – How Can You Protect Yourself?
Hospitalizations can lead to an increase in the number of medications taken.
Polypharmacy, defined as the use of multiple drugs or the use of more drugs than are medically necessary, is a growing concern for seniors. Surprisingly, research shows that almost 50% of older adults take at least one medication that isn’t medically necessary. Unsurprisingly, polypharmacy increases the risk of drug interactions and adverse drug reactions. Furthermore, there is a strong established relationship between polypharmacy and negative health consequences.
Importantly, research shows that hospitalizations can make polypharmacy worse for patients.
For more information, including tips to reduce the risk of too many medications, read Doctors Prescribe Too Many Medications.
Falls among seniors are common and dangerous.
Unfortunately, falls are a common and devastating complication of hospital stays, particularly for elderly patients. In fact, the Agency for Healthcare Research and Quality estimates that 700,000 to 1 million hospitalized patients fall each year. Unsurprisingly, senior patients account for most of these falls. However, any patient, regardless of age or physical ability, can fall due to a medical condition, medications, surgery, procedures, or diagnostic testing that can leave them weakened or confused. But seniors who are experiencing delirium, are prescribed psychoactive medications (e.g., benzodiazepines), or struggle with strength, mobility, or balance have a higher risk.
Furthermore, 30-50% of falls in hospitals result in injuries, including fractures, internal bleeding, and head trauma. Patients injured in a fall often require additional treatment and may have to stay in the hospital longer than originally expected. In one study, falls with injuries extended hospital stays by an average of 6.3 days. Sadly, some patients die due to fall-related injuries.
Lastly, injuries from a fall can easily lead to immobility, which itself can lead to serious harm. Read below for more information on the impacts of limited physical activity.
Fall prevention programs don’t always help.
Many hospitals use bed alarms that notify staff when a patient who is at risk of falling gets off the bed. Although it sounds like a good plan, a study found that bed alarms don’t statistically or clinically reduce the number of fall-related events.
For more information, read:
- Why are Hospital Patients at Risk for Falls?
- Hospital Fall Prevention Programs – Harmful or Helpful?
Limited physical activity leads to deterioration.
Staying in bed for prolonged periods of time is unhealthy for most people but is particularly dangerous for seniors. When seniors spend just a few days in bed, muscles can deteriorate significantly enough to cause severe long-term consequences. And staying in bed can increase the risk of blood clots, pressure sores, and pneumonia. One study found that 35% of patients 70+ years old were more disabled upon discharge than when they were admitted.
Yet, it doesn’t take excessive amounts of movement to improve patients’ conditions. One study found that senior patients who walked 275+ steps per day had a significant reduction in risk of being readmitted within 30 days.
Fall prevention programs are part of the problem.
Although designed to reduce the risks for seniors in the hospital, fall prevention programs keep patients in bed, even when they could benefit from physical activity. Ideally, staff members would spend time each day helping patients increase their mobility. However, staff don’t have time to increase patients’ physical activity, leaving patients immobile for most of the day.
One woman’s tale.
A Kaiser Health News article on the impact of hospital policies that limit patient mobility shares the story of Dorothy. In her 80s, she lived independently with no mobility issues. After 3 days confined to a hospital bed after a dizzy spell, she lost her mobility. Sadly, it took 3 months of rehab before Dorothy could walk again.
Hospitalizations increase the risk of dangerous blood clots.
A deep vein thrombosis (DVT) occurs when a blood clot forms in a large vein, usually the arm or leg. And an untreated DVT can break off and move to the lungs, causing a life-threatening pulmonary embolism.
In general, seniors have an increased risk of developing these dangerous blood clots. And being in the hospital increases the risk, particularly if patients experience physical trauma, surgery, and/or prolonged immobility. And it’s not just the time in the hospital that is a cause for concern. About 50% of all blood clots occur within 3 months of a hospitalization or surgery. Furthermore, deaths from blood clots are more common than you might think. In fact, blood clots are the leading cause of preventable deaths in hospitals in the US. However, nearly 50% of all hospitalized patients do not receive appropriate preventive measures.
What can you do?
You can follow these suggestions developed by the Centers for Disease Control and Prevention (CDC):
Before a hospital stay:
- Discuss your potential risk factors and family health history with your doctor.
- Ask if you will need prevention measures for blood clots while in the hospital.
- Make sure that all of your doctors know your blood clot risks and ask for a prevention plan.
Before hospital discharge:
- Ask your doctor how to prevent blood clots when you are at home.
- Discuss the signs and symptoms of blood clots.
- Make sure you know what to do if you experience the signs or symptoms of a blood clot.
When you or your loved one returns home:
- Follow instructions and take medications as prescribed.
- Move around, if confined to bed or a wheelchair, have someone help you move your arms and legs.
- Notify your doctor if you experience signs or symptoms of blood clots.
For more information, visit the StopTheClot.org website.
Seniors are more susceptible to pressure sores.
As noted above, many hospitalized seniors spend most of their days in bed. And staying in one position for prolonged periods can lead to painful, potentially dangerous, pressure sores. Although this can happen to any patient, seniors have a higher risk because as we age, our skin thins, loses elasticity, and becomes more fragile. Unfortunately, pressure sores are typically accompanied by severe complications including pain, depression and infections. These complications then lead to further health deterioration, prolonged suffering, longer hospitalization, and in some cases, early death.
Read What You Need to Know About Pressure Sores for more information.
Seniors are particularly impacted by sleep loss.
Getting a good night sleep in the hospital is hard for all patients. For starters, it’s noisy and often lit more brightly than at home. On top of that, staff interrupt sleep to take blood, check vitals, and perform other patient care tasks. And of course, pain and other medical conditions can make it hard to sleep.
However, older patients face unique risks due to sleep loss during hospitalization. Seniors can experience worse health outcomes from sleep deprivation, including cardiometabolic syndrome, which can lead to severe cardiovascular diseases and strokes. Additionally, sleep loss among seniors also leads to an increased risk of delirium.
Can sleep conditions improve for seniors in the hospital?
Sleep medications can help seniors sleep, but since seniors are at risk of polypharmacy, the choice of medication must be based on the patient’s profile to minimize side effects. To avoid adding another medication to an already long list, trying a non-medication intervention is worth a try. Even though some of these interventions have yet to be proven helpful, consider talking to the doctor and nursing staff about these possible ways to improve the sleep for hospitalized patients:
- Pain treatment.
- Relaxation therapy.
- Eye masks and ear plugs.
- Scheduling care to reduce/avoid nighttime interruptions.
- Bright light therapy during the day.
- White noise machines.
For more information and tips, read How to Sleep Better in the Hospital.
Anesthesia impacts seniors.
Seniors have an increased risk of issues during and after surgical procedures. Why? Some common health problems related to aging, such as increased blood pressure, clogged arteries, and heart and lung disease, increase the chances of side effects or complications from surgery.
And, since older brains are more vulnerable to anesthesia, seniors are more likely to develop either of these anesthesia-related conditions:
- Postoperative delirium. This is a temporary condition that causes confusion and disorientation. Additionally, patients may have problems with memory and paying attention. Interestingly, this delirium may not start until a few days after surgery and may come and go. Fortunately, it usually disappears after a week or so.
- Postoperative cognitive dysfunction (POCD). This condition is more serious since it can lead to ongoing struggles with long-term memory, concentration and thinking. Certain medical conditions, including heart disease (especially congestive heart failure), lung disease, Alzheimer’s disease, a past stroke, and Parkinson’s disease increase the risk for POCD. However, since many of these cognitive struggles are common in seniors, evaluating the patient before and after surgery is the only way to accurately diagnose this condition.
For tips on how to reduce anesthesia risks in seniors, visit the American Society of Anesthesiologist’s website.
Dementia patients face more complications and worse outcomes.
The risks for seniors in the hospital is even greater when the patients have cognitive decline. In fact, there is growing evidence that hospitals are not safe places for people with dementia.
People with dementia have worse outcomes, longer lengths of stay, higher mortality rates and are more likely to be readmitted, as compared to people without dementia. One report states patients with dementia have a five-fold increase in mortality rates. And researchers in Scotland found that hospital patients with dementia stay nearly two weeks longer when compared to those without dementia.
And it doesn’t have to be this bad. Studies show that when compared with non-dementia patients, “hospitalized dementia patients have higher rates of potentially preventable complications that might be responsive to nursing interventions”. For instance, an Australian study found that compared to patients without dementia, hospital patients with dementia are more than twice as likely to experience key preventable hospital-acquired complications – urinary tract infections, pressure ulcers, pneumonia and delirium. These 4 key complications led to an average increased hospital stay of 3.6 days. And dementia patients are more likely to fall or experience sepsis infections.
Interestingly, experts don’t know if dementia patients have worse outcomes due to the level of care received, the dementia, or both.
To make matters even worse for dementia pains, studies show that under-treatment for acute pain is more likely among patients with dementia, meaning dementia patients may suffer from more pain than necessary.
Finally, although many dementia patients experience difficulties eating and drinking, evidence suggests that hospitalization may make these problems worse.
The period after a hospitalization poses risks for seniors.
After hospital stays, all patients face a short-term period of increased susceptibility to disease and adverse events, which can lead to hospital readmissions and even death. Research indicates patients may face a lack of resilience to many types of illnesses during this period. Unsurprisingly, this period, called post-hospital syndrome, is particularly dangerous for patients over 65. For example, within 30 days of hospital discharge, almost 1/5 of Medicare patients develop an acute medical problem that leads to another hospitalization.
You might guess that patients readmitted to the hospital are likely admitted for the same medical condition for which they were in the hospital in the first place. However, readmission is often caused by a fall, an infection or a completely different medical condition. For instance, among patients hospitalized for heart failure, only 37% of readmissions were for heart failure. And among those initially hospitalized for pneumonia, only 29% of readmissions were for pneumonia.
What causes post-hospital syndrome?
For starters, being in the hospital is stressful. Hospital patients often don’t sleep or eat well, have their normal circadian rhythms disrupted, experience pain, face mentally challenging situations, take medications that can cause cognitive and physical impairment, and become weaker from prolonged time in bed. Each of these changes can make it harder to recover, impair a patient’s ability to fend off disease, and increases susceptibility for mental error.
These physical and cognitive challenges can also make it harder for seniors to follow discharge instructions, including following complicated medication regimens. To reduce the risk of problems after a senior leaves the hospital, read these posts:
- Tips for Hospital Discharges
- Majority of Patients Don’t Understand Discharge Instructions
- 10 Tips for Avoiding Medication Issues After a Hospital Stay
Consider the needs of seniors when choosing a hospital.
Certainly, any of the issues described in this post can happen at any hospital. However, some hospitals are better than others when it comes to caring for seniors. Fortunately, many health systems have senior-friendly policies that reduce the risks for seniors in the hospital.
How can you find a hospital with a focus on keeping seniors safe?
For starters, you can look for a hospital designated as an “Age-Friendly Health System”. These hospitals are committed to providing appropriate, evidence-based care for seniors, and causing no harm. Additionally, these hospitals have committed to considering the desires of seniors and their families. Visit the IHI website to see the list of the thousands of hospital systems deemed friendly to seniors.
Additionally, you can search online with the term “acute care for elders” and the name of your city or hospital to learn about programs and policies regarding senior care.
For general tips on factors to consider when choosing a hospital, read:
- How to Choose a Hospital.
- What’s Your Hospital’s Safety Record? Is Your Hospital Safe?
- Is Your Hospital Safe? Are Programs in Place to Avoid Dangerous “Never Events”?