Hazards of Hospitalization of the Elderly
Why Hospitals Aren’t the Best Place for Older Adults
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Avoiding hospitalizations for the elderly should be a priority for all family caregivers. Due to a lack of health care experience—family caregivers are unaware of issues that result in hospital emergency room visits until they occur. For the elderly, being hospitalized and avoiding the next hospitalization should be a priority, but many lack insight into habits that contribute to ongoing health issues.
For adults and the elderly interested in health and well-being, many actions can be taken to stay healthy and avoid emergency room visits. In this article, I will share tips from my 20 years of experience as a care manager, the medical power of attorney and guardian, and why hospitals aren’t the best place for older adults.
Also, I’ll include links to statistics and articles from health insurers and researchers about the most common conditions that cause unintentional harm or death from medical misdiagnosis or treatments that don’t address the issue. The hazards of hospitalization of the elderly are significant and can be avoided by being proactive.
Hazards of Hospitalization of the Elderly Begin in the Emergency Room
According to Coverys Emergency Department Insights, almost 50% of patients hospitalized begin as emergency room patients. The majority of all-age emergency room medical claims involve a failure or delay in making a diagnosis, including the lack of an appropriate patient or family history and physical as well as the inappropriate ordering of diagnostic tests.
- 56% of issues are diagnosis-related
- 20% involve medical treatment
- 9% are medication related
- 4$ surgery or procedure-related
What does this mean for all consumers, the elderly, and their caregivers? Potential medical errors and harm are shared by the patient and the physician—even though many times it is the actions of the physician who are questioned. Treatment of the elderly in hospitals should be closely monitored by family members when possible.
The history and physical—H&P in medical speak—or health history of a patient is a critical component of helping an emergency room physician accurately diagnose a condition. When an elderly adult arrives in the emergency room unaccompanied, it may be difficult for emergency room staff to receive accurate information if the older adult cannot speak or think clearly due to the reason for admission.
For all adults, having a knowledgeable family member or caregiver accompany you to the emergency room is critical to making sure that your condition is diagnosed correctly. Having an advocate is essential to getting the right treatment in the hospital.
What is A DNR?
All persons admitted to hospitals are asked about a DNR and extensive medical treatment. If you don’t know what this means, listen to The Caring Generation podcast Do Not Resuscitate: What is a DNR. An interview with Dr. Richard Balaban sheds light on why physicians find it challenging to discuss the end of life care.
Why the Elderly Aren’t Admitted for Hospital Treatment
If you have an elderly parent with health issues and have been to the emergency room, you may have experienced your parent being discharged quickly after arriving at the hospital. Hospitals don’t want to admit the elderly for the risk of being financially penalized.
Healthcare bias also exists in treating the elderly versus the young. Persons diagnosed with dementia are viewed as less likely to improve also receive less than appropriate care. The treatment of the elderly in hospitals depends on the skills of family advocates to ask for and coordinate care with medical providers.
If you are an aging adult, you have to be more proactive, insistent, and tenacious to get the care you need. Women, more than men, are more commonly misdiagnosed by doctors or turned away for being hypochondriacs.
Patient Education and Safety – Women Are At Higher Risk of Misdiagnosis and Medical Errors
An interview with Dr. Kathryn McDonald, a patient-safety expert from the Johns Hopkins Schools of Nursing and Medicine, sheds light on common risks for patients admitted to the hospital and other medical settings. A study by experts at the Johns Hopkins Armstrong Institute for Patient Safety and Quality confirms that diagnostic errors are the most catastrophic and most costly of medical mistakes.
Diagnostic errors for all adults leading to death or permanent severe disability are associated with:
- Misdiagnosed cancers: lung, breast, colorectal, prostate, and skin – 37.8%
- Vascular events: heart attacks, blood clots, and blockages, ruptured aorta – 22.8%
- Infections: sepsis, meningitis, encephalitis, spinal infection, pneumonia, heart infection – 13.5%
Among diagnostic-error cases of varying severity, the patient’s median age was 49, and more than half were female. This research confirms the importance of women taking an interest in health, well-being, and self-advocacy to get proper and timely medical care.
Caregivers—still more women than men—experience health concerns resulting from the stress of caregiving. In the podcast, Caring for My Elderly Mother is Killing Me, I share tips for managing overwhelming care situations. An interview with a journalist, Maya Dusenbery, reinforces the importance of women getting the right diagnosis.
What Adults Can Do to Avoid Health Hazards
For all adults, regular medical care that continues after high school offers the most significant opportunity to avoid chronic disease. The hazard? Healthy people, or people who feel relatively good, go about life lacking an understanding of the benefit of seeing a doctor for an annual checkup or bloodwork. Bloodwork is a preventative measure that can identify early heart disease issues, diabetes, and other chronic conditions.
Early identification of a health condition means that adults have the opportunity to change health behaviors that contribute to worsening conditions. In some cases, health habits can be adjusted to avoid taking medications that can result in other unexpected health issues.
For example, women taking birth control pills or hormones can acquire high blood pressure, high cholesterol, elevated triglycerides, or weight gain that causes other health conditions. While medications are seen as an easy cure for a health condition, the better option is to address the health habit causing the concern and avoid taking medication.
Managing Medications in the Elderly
The more medications are taken, the greater likelihood of acquiring new health issues as an effect of taking the medicines. Hazards include the risk of one drug interacting with another. The treatment of the elderly in hospitals depends on having an advocate or medical power of attorney who remains in communication with physicians to ensure that medications are not changed or if adjusted to confirm that there have been no past allergies or negative medication interactions.
The hazards of hospitalization of the elderly include medication-related events. Not taking the right medications, forgetting to take medications, or not taking prescription drugs on schedule take elderly adults to hospital emergency rooms.
As a care manager, significant risks for my elderly clients were physicians changing medications without discussing the effects of the change with me as the guardian or medical power of attorney. Most of my elderly clients would never question the recommendation of a doctor. Doctors who may be rushed to provide treatment avoid lengthy discussions about changing medication when it’s easier to have a patient agree.
These medication changes sent my elderly clients to the hospital emergency room. Results from unauthorized medication changes were severe allergic reactions and, in one case, almost a stroke when a physician discontinued my client’s evening blood pressure medication.
Understand Health Diagnosis and the Medications Prescribed
My advice? Have thorough conversations about all medication recommendations, changes, and discontinuances. Even more important—take the time to understand the diagnosis that results in the recommendation for medication and if you can, change your health habits to avoid the need for the drug.
Create a relationship with a physician who can learn about you and your health history. Patients who have a regular physician, attend regular appointments, and participate in preventive care have fewer health surprises.
If you take medications, monitor them closely. If you see multiple physicians or specialists, make sure each physician has an accurate list of all drugs and over-the-counter supplements. Being proactive can avoid the hazards of hospitalization of the elderly. Have a thorough understanding of health conditions so that you understand how each diagnosis affects your health short and long-term.
Being Inactive Results in Physical Weakness
The hazards of hospitalization of the elderly include lying in bed and being inactive. For the elderly, who may be generally inactive, several days in a hospital bed can result in higher levels of physical disability. The ability of older adults to live independently is dependent on the ability to perform activities of daily living that include: bathing, dressing, eating, toileting, sitting, standing, walking, and all general day-to-day tasks.
These daily activities may be taken for granted by younger adults until a physical injury occurs. A knee injury can make walking up and down stairs more difficult. A frozen shoulder not treated by exercises or physical therapy can turn into a permanent disability.
Physical inactivity results in physical weakness, loss of muscle, and disability for persons of all ages, not only the elderly. Older hospitalized adults who have physical work to do after being discharged to home. This physical work involves exercise and activities to return to the same level of mobility or activity before the hospitalization.
Some elderly are transferred to nursing homes for physical rehabilitation and strengthening. However, rehab isn’t a one-time event. The exercises and habits taught in recovery must be carried on after returning home if the goal is avoiding another hospitalization.
It’s Not Good to Be Old
The secret to avoiding hazards of hospitalization of the elderly is making health and wellness a priority beginning in youth. My elderly grandmother lived well into her nineties. Her favorite saying on the rare occasions she did not feel well was, “it’s no good to be old.”
My advice? Do what you can today to improve your health by learning about health diagnosis, medication effects, eating a healthy diet, incorporating daily exercise into your schedule, and thinking positively.
There are so many risks for the treatment of the elderly in hospitals that transfers to home care. In the twenty years I coordinated care for my clients I learned many of the details that are missed by physicians who are unfamiliar or disinterested in the care of the elderly. These details are included in my online caregiver course called Stay at Home.
If you are a caregiver, learn from the health experiences of the person for whom you care. Share these learnings with your family, including your children, so that they can live to a healthy and fulfilling old age.
To learn about managing care for elderly parents, consider my online caregiving course: Stay at Home Taking Care of Elderly Parents at Home and Beyond.
©2021 Pamela D Wilson, All Rights Reserved.