Skip to main content Accessibility help
×
Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-19T16:46:09.385Z Has data issue: false hasContentIssue false

Chapter 52 - Hospital-Based Care

from Section IV - Principles of Care for the Elderly

Published online by Cambridge University Press:  30 June 2022

Jan Busby-Whitehead
Affiliation:
University of North Carolina, Chapel Hill
Samuel C. Durso
Affiliation:
The Johns Hopkins University, Maryland
Christine Arenson
Affiliation:
Thomas Jefferson University, Philadelphia
Rebecca Elon
Affiliation:
The Johns Hopkins University School of Medicine
Mary H. Palmer
Affiliation:
University of North Carolina, Chapel Hill
William Reichel
Affiliation:
Georgetown University Medical Center
Get access

Summary

As Medicare has focused more on hospital readmissions and care transitions over time, programs and movements aimed at providing geriatric-focused care have developed nationally. These programs aim to minimize and prevent hazards of hospitalization, decrease readmissions, provide safer transitions to the post-acute setting, and decrease length of stay while acknowledging and addressing specific care considerations of hospitalized older adults, such as dementia, sensory impairment, and mobility impairment. Inpatient geriatric assessments help providers tailor care plans to the specific needs of individual hospitalized older adults and determine their post-acute care needs, and also help with appropriate counseling of family and caregivers. Prevention measures are vital during hospitalization of older adults, who are at higher risk of delirium, pressure injury, falls, aspiration, malnutrition, sleep disturbances, and venous thromboembolism. Detailed transition plans and specialized discharge summaries are important to highlight the needs of older adults as they transition to post-acute care settings, and should allow for providers to resume the care plan seamlessly, including continuation of advanced care planning conversations.

Type
Chapter
Information
Reichel's Care of the Elderly
Clinical Aspects of Aging
, pp. 641 - 649
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

IHI Initiatives: Age-Friendly Health Systems.Google Scholar
Fulmer, T, Mate, KS, Berman, A. The Age-Friendly Health System imperative. J Am Geriatr Soc. 2018; 66(1):2224.Google Scholar
Allen, K, Ouslander, JG. Age-Friendly Health Systems: Their time has come. J Am Geriatr Soc. 2018; 66(1):1921.CrossRefGoogle ScholarPubMed
Røsvik, J, Rokstad, AMM. What are the needs of people with dementia in acute hospital settings, and what interventions are made to meet these needs? A systematic integrative review of the literature. BMC Health Serv Res. 2020; 20(1):723.CrossRefGoogle Scholar
Palmer, RM. The Acute Care for Elders unit model of care. Geriatr. 2018; 3(3):59.CrossRefGoogle ScholarPubMed
Hobday, JV, Gaugler, JE, Mittelman, MS. Feasibility and utility of online dementia care training for hospital staff: The CARES® dementia-friendly hospitalTM program. Res Gerontol Nurs. 2017; 10(2):5865.CrossRefGoogle ScholarPubMed
Castellucci, M. UNC Health Care trains staff to treat dementia patients. Mod Healthc. October 2019. www.modernhealthcare.com/care-delivery/unc-health-care-trains-staff-treat-dementia-patients.Google Scholar
Covinsky, KE, Palmer, RM, Fortinsky, RH, et al. Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: Increased vulnerability with age. J Am Geriatr Soc. 2003; 51(4):451458.Google Scholar
Amador, LF, Reed, D, Lehman, CA. The Acute Care for Elders unit: Taking the rehabilitation model into the hospital setting. Rehabil Nurs. 2007; 32(3):126131.Google Scholar
Flood, K, Booth, K, Vickers, J, et al. Acute Care for Elders (ACE) team model of care: A clinical overview. Geriatrics. 2018; 3(3):50.CrossRefGoogle Scholar
Palmer, RM, Landefeld, CS, Kresevic, D, Kowal, J. A medical unit for the acute care of the elderly. J Am Geriatr Soc. 1994; 42(5):545552.Google Scholar
Landefeld, CS, Palmer, RM, Kresevic, DM, Fortinsky, RH, Kowal, J. randomized, A trial of care in a hospital medical unit especially designed to improve the functional outcomes of acutely ill older patients. N Engl J Med. 1995; 332(20):13381344.Google Scholar
Fox, MT, Persaud, M, Maimets, I, et al. Effectiveness of acute geriatric unit care using acute care for elders components: A systematic review and meta-analysis. J Am Geriatr Soc. 2012; 60(12):22372245.Google Scholar
Vaartio‐Rajalin, H, Fagerström, L. Professional care at home: Patient‐centredness, interprofessionality and effectivity? A scoping review. Health Soc Care Community. 2019; 27(4):e270e288.Google Scholar
Barrett, D. Admission avoidance: Hospital at home. Br J Community Nurs. 2019; 24(5):238240.Google Scholar
Shepperd, S, Iliffe, S, Doll, HA, et al. Admission avoidance hospital at home. Cochrane Database Syst Rev. 2016; 2016(9):CD007491.Google Scholar
Gonçalves-Bradley, DC, Iliffe, S, Doll, HA, et al. Early discharge hospital at home. Cochrane Database Syst Rev. 2017; 2017(6):CD000356.Google Scholar
Parke, B, Friesen, K. Code Plus: Physical Design Components for an Elder Friendly Hospital, 2nd edition. Surrey, BC: Fraser Health,2015.Google Scholar
Cahnman, SF. Hospital design for seniors. Healthc Des. September 22, 2017. https://healthcaredesignmagazine.com/trends/perspectives/hospital-design-seniors.Google Scholar
Ellis, G, Gardner, M, Tsiachristas, A, et al. Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database Syst Rev. 2017; 2017(9):CD006211.Google Scholar
Middleton, A, Graham, JE, Lin, YL, et al. Motor and cognitive functional status are associated with 30-day unplanned rehospitalization following post-acute care in Medicare fee-for-service beneficiaries. J Gen Intern Med. 2016; 31(12):14271434.Google Scholar
Burke, RE, Whitfield, EA, Hittle, D, et al. Hospital readmission from post-acute care facilities: Risk factors, timing, and outcomes. J Am Med Dir Assoc. 2016; 17(3):249255.CrossRefGoogle ScholarPubMed
Oh, ES, Fong, TG, Hshieh, TT, Inouye, SK. Delirium in older persons: Advances in diagnosis and treatment. JAMA – J Am Med Assoc. 2017; 318(12):11611174.Google Scholar
Dale, MC, Drickamer, MA, Sloane, PD. Geriatric-specific standards for information transfer between nursing homes and acute care hospitals. J Am Med Dir Assoc. 2020; 21(4):444446.Google Scholar
Bernacki, RE, Block, SD. Communication about serious illness care goals: A review and synthesis of best practices. JAMA Intern Med. 2014; 174(12):19942003.Google Scholar
Chong, E, Ho, E, Baldevarona-Llego, J, et al. Frailty in hospitalized older adults: Comparing different frailty measures in predicting short- and long-term patient outcomes. J Am Med Dir Assoc. 2018; 19(5):450457.Google Scholar
Dharmarajan, K, Swami, S, Gou, RY, Jones, RN, Inouye, SK. Pathway from delirium to death: Potential in-hospital mediators of excess mortality. JAGS. 2017; 65: 10261033.Google Scholar
Moore, ZE, Patton D. Risk assessment tools for the prevention of pressure ulcers. Cochrane Database Syst Rev. 2019 (Jan. 31); 1(1):CD006471.Google Scholar
Qaseem, A, et al. Risk assessment and prevention of pressure ulcers: A clinical practice guideline from the American College of Physicians. Ann Intern Med. 2015; 162(5):359369.Google Scholar
Mandell, LA, Niederman, MS. Aspiration pneumonia. N Engl J Med. 2019; 380:651663.Google Scholar
Feldblum, I, German, L, Castel, H, Harman-Boehm, I, Shahar, DR. Individualized nutritional intervention during and after hospitalization: The nutrition intervention study clinical trial. JAGS. 2011; 59(1):10.Google Scholar
Arora, VM, Stewart, N. Sleep in hospitalized older adults. Sleep Med Clin. 2018 (Mar.); 13(1):127135.Google Scholar
Schunemann, HJ, Cushman, M, Burnett, AE, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: Prophylaxis for hospitalized and nonhospitalized medical patients. Blood Adv. 2018; 2:3198.CrossRefGoogle ScholarPubMed
Mahé, BJF, Bergmann JF, d’Azémar, P, Vaissie, JJ, Caulin, C. Lack of effect of a low-molecular-weight heparin (nadroparin) on mortality in bedridden medical in-patients: A prospective randomised double-blind study. Eur J Clin Pharmacol. 2005 (Jul.); 61(5–6):347351.Google Scholar
Cave, B, Hough, A, Dobes, PP. Extended venous thromboembolism prophylaxis in medically ill patients. Pharmacotherapy. 2018; 38(6):597609.CrossRefGoogle ScholarPubMed
Growdon, ME, Shorr, RI, Inouye, SK. The tension between promoting mobility and preventing falls in the hospital. JAMA Intern Med. 2017; 177(6):759.Google Scholar
Inouye, SK. Delirium – A framework to improve acute care for older persons. JAGS. 2018; 66:446451.Google Scholar
Dharmarajan, K, Swami, S, Gou, R, Jones, RN, Inouye, SK. Pathway from delirium to death: Potential mediators of excess mortality. JAGS. 2017; 65:10261033.CrossRefGoogle ScholarPubMed
Inouye, SK, Bogardus, ST Jr., Charpentier, PA, et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl JMed. 1999; 340:669676.Google Scholar
Eslami, M, Tran, HP. Transitions of care and rehabilitation after fragility fractures. Clin Geriatr Med. 2014; 30(2):303315.Google Scholar
Coleman, EA, Boult, C. Improving the quality of transitional care for persons with complex care needs. J Am Geriatr Soc. 2003; 51(4):556557.Google Scholar
Unnewehr, M, Schaaf, B, Marev, R, Fitch, J, Friederichs, H. Optimizing the quality of hospital discharge summaries – A systematic review and practical tools. Postgrad Med. 2015; 127(6):630–639.Google Scholar
Kripalani, S, LeFevre, F, Phillips, CO, Williams, M V, Basaviah, P, Baker, DW. Deficits in communication and information transfer between hospital-based and primary care physicians. JAMA. 2007; 297(8):831841.Google Scholar
Kergoat, MJ, Latour, J, Julien, I, et al. A discharge summary adapted to the frail elderly to ensure transfer of relevant information from the hospital to community settings: A model. BMC Geriatr. 2010; 10:69.Google Scholar
Vasilevskis, EE, Ouslander, JG, Mixon, AS, et al. Potentially avoidable readmissions of patients discharged to post-acute care: Perspectives of hospital and skilled nursing facility staff. J Am Geriatr Soc. 2017; 65(2):269276.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×