Sicker on Admission, Not 100% on Discharge?

The Kaiser Health Network (KHN) and U.S. News ran a story in July about elders’ admission to hospitals. They may be sicker on admission and when discharged, may not be able to care for themselves, needing help with ADLs. Elderly Hospital Patients Arrive Sick, Often Leave Disabled focuses on how hospitals care for elders, and a “trend” to create a special unit just for patients who are elderly.

How hospitals handle the old — and very old — is a pressing problem. Elderly patients are a growing clientele for hospitals, a trend that will only accelerate as baby boomers age. Patients over 65 already make up more than one-third of all discharges, according to the federal government, and nearly 13 million seniors are hospitalized each year. And they stay longer than younger patients.

Many seniors are already suspended precariously between independent living and reliance on others. They are weakened by multiple chronic diseases and medications.

One bad hospitalization can tip them over the edge, and they may never recover, said Melissa Mattison, chief of the hospital medicine unit at Massachusetts General Hospital. “It is like putting Humpty Dumpty back together again,” said Mattison, who wrote a 2013 report detailing the risks elderly patients face in the hospital.

If one considers the special circumstances for elder patients, it makes sense that hospitals may want to be prepared for these patients. But, the way the medical system works currently, “the unique needs of older patients are not a priority for most hospitals… Doctors and other hospital staff focus so intensely on treating injuries or acute illnesses — like pneumonia or an exacerbation of heart disease — that they can overlook nearly all other aspects of caring for the patients” according to one expert quoted for the article.

Some hospitals have special units for these patients, referred to as Acute Care for Elders (ACE) units. “ACE units have been shown to reduce hospital-inflicted disabilities in older patients, decrease lengths of stay and reduce the number of patients discharged to nursing homes. In one 2012 Health Affairs study,  … researchers found that hospital units for the elderly saved about $1,000 per patient visit.” Not only do these units save money, according to the article, patients in these units seem to be better when discharged. 

If you discuss this in class, have your students find out whether any of the local hospitals have a similar unit.  It makes a difference.