Older Patients: At Risk in the Hospital

You might think that helping an older adult get to the hospital is as simple as dropping them off at "Admitting" and allowing the hospital staff to take care of the rest. Think again. Older patients desperately need your help because hospital risks are at an all-time high; even a short stay can be fraught with medical errors, medication mistakes, falls, infectious diseases and a host of other life threatening events for elderly in the hospital.

Hospital medical staff wants the very best medical care for your older loved one, but they are under tremendous pressure. Few can overcome patient overload, a nationwide nursing shortage and a developing physician shortage. Many hospitals in the US are suffering from financial duress, rendering them unable to accommodate the many needs and vulnerabilities of older adults.

Enter the patient advocate. You as a family member or good friend must monitor older patients' medical care and provide support during a hospital stay to minimize hospital risks.

Hospital Risks For Older Patients

1. Delirium occurs in 1/3 of hospitalized patients over the age of 65 and in more than 70 percent of older patients in Intensive Care Units. Reasons for this include serious illness, exposure to new medications, disruption of normal routines and sleep disturbance. Family members are often the first to notice changes that might indicate delirium.
2. If an older adult cannot reposition himself, he is at risk for pressure ulcers (bed sores). Pressure ulcers affect 1 million adults annually.
3. Older patients may have multiple medical issues, requiring several specialists to be involved in his case. This can be confusing and difficult to coordinate for any patient.
4. New medications may be introduced, which can lead to side effects. Older patients may already be taking multiple medications, which can lead to adverse effects.
5. Older adults are at risk for falls, especially if they are sedated or disoriented. Among older adults, falls are the leading cause of injury and deaths.
6. Older adults can be at risk for malnutrition. Studies cite that 58 percent of patients 65 and older have problems eating. The nutritional status of older patients has been reported to diminish in hospitals. This can slow recovery.
7. The spread of infectious diseases such as MRSA and pneumonia are rampant in hospitals. The reason pneumonia acquired in the hospital is more severe may be due to the more aggressive infecting organisms, making it harder to treat.

What A Patient Advocate Can Do

1. Have The Patient's Medical History. Bring in your loved one's complete medical history. An older patient in the hospital may be too ill to gather the information.
2. Have A List of Patient's Medications. Bring a current list of the patient's medications, including over-the-counter drugs and any herbs and supplements taken. Include any allergies to medications.
3. Bring Eyeglasses And Hearing Aids. Be sure your loved one has these essentials handy to better see and hear what is happening.
4. Make the Patient's Hospital Room Like Home. Older patients do better in the hospital if some of their routine and sense of familiarity is preserved. Bring in the outside world to their hospital room. This includes a cozy comforter, photos of family and friends, a clock to help them keep track of time, bathrobe, their address book should they want to contact loved ones, books, newspapers, MP3, CD, DVD or tape players with familiar programs or music.
5. Practice Bed Sore Prevention. If the patient is unable to reposition himself in bed, monitor how many times his body is turned to prevent pressure ulcers. Ask the patient's primary nurse to help you with this.
6. Meet The Doctors. Be present during doctors' rounds to have face-to-face interactions with your loved one's physicians. You want these medical professionals to see you as a human being who is involved with the patient. Create a list of questions ahead of time and document the answers in a notebook.
7. Be Aware Of Behavior And Mood Changes. Document in a notebook how the patient is doing on a daily basis. Be aware of any sudden mood or cognitive changes in the patient such as drowsiness, apathy, confusion, little or no speech or movement, agitation or hallucinations. If you notice a sudden change, bring it to the attention of the patient's physician and primary nurse and ask for an evaluation.
8. Monitor Meals. Sometimes older patients have a difficult time eating and may need assistance. Hospital workers may be too quick to take away meal trays before the patient has had time or the inclination to eat. Monitor dietary restrictions to make sure the patient receives meals the doctor has ordered. You can also bring in meals from home, but check with the patient's primary nurse first.
9. Prevent Falls. If your loved one is at risk for falling, be at bedside at all times. You can create a Family Advocate Team with other loved ones taking shifts. This prevents the need for restraints.
10. Prevent Diseases In The Hospital. To prevent the spread of hospital-acquired infectious diseases such as MRSA and pneumonia, ask everyone who comes in contact with the patient to wash their hands. An older patient may not be up to this task. You can create a hand-made sign to be placed on the wall above the patient's bed that says, "Please wash your hands before touching me." Place anti-bacterial gel by the patient's bed and ask everyone to use it. Try to get your older loved one into a private hospital room this cuts down on the cross contamination of diseases considerably.
11. Provide Comfort. Last but not least, provide comfort to the patient. He or she may be frightened in the hospital and may feel even more uncomfortable with the loss of control than you might. Reassure him that he will get better and that you and your Family Advocate Team are watching out for him.