Don’t let the title of this blog mislead you. By and large, hospitals are a safe place to be when we require the care they provide. Unfortunately, hospitals may not be the best place for your elderly loved ones particularly at a time when they are most vulnerable.
My mother spent a long, difficult three weeks in a nationally acclaimed hospital. She had been referred there for a cardiac procedure. We knew there were risks and we accepted them. Sadly, it was the responses to the potential risks, when they occurred, that were the problem. At one point I was convinced she would not be discharged alive. We had her transferred to a local hospital and it was there that she began her recovery. Ultimately she was discharged to home.
For the adult care provider of elderly parents, a hospital admission can be extremely stressful. A hospital admission can be potentially devastating the elderly. According to the CDC, in 2010, adults aged 85 and over accounted for only 2% of the U.S. population yet they accounted for 9% of hospital discharges. This group is less likely to be discharged home and more likely to die in the hospital. However, it is possible to avoid the hazards of a hospitalization with discharge to home as the outcome.
Keeping Your Parent Safe in the Hospital
Safety is a top priority for hospitals. In fact, hospitals across the nation hold a “Patient Safety Awareness Week” every March. During my 30 years in the hospital setting I saw many changes, programs and new evidenced based practices implemented in the effort to ensure patients are safe. The measures have been successful. However, negative things can and do still happen. Reduced mobility and delirium are significant risks for the hospitalized elderly. These are hazards that can be avoided.
The Hazards of Bedrest
The elderly are likely to have limited mobility upon entering the hospital. They may have arthritis pain, use a walker, cane, or have issues with balance. Once in the hospital, their mobility is further reduced by “bedrest.” Deconditioning leads to reduced mobility and functionality. This is often noted by day two of a hospitalization. Nurse staffing can further impact mobility as their numbers are stretched thin. They often don’t have the time to take their patients for a walk (if appropriate) or to provide range of motion exercises. Decreased mobility increases the risk of falling. Serious fractures with related complications are likely to occur when elderly patients fall.
Don't Confuse Delirium for Dementia
Some 30 to 40% of hospitalized older adults will experience delirium. The onset of delirium is rapid and may be sporadic. The elderly patient with delirium may be confused and will have difficulty focusing. He or she may be distracted easily or less responsive than usual. They may be restless, agitated, and have hallucinations. Often, they reverse day/night cycles, referred to as “sun downing.” You may notice changes in their personality. Causes include dehydration, medications, withdrawal from alcoholism or other addictive substances, sleep deprivation, electrolyte imbalances, infection, and anesthesia used in surgery or during procedures. Delirium is not the same as dementia. Unfortunately, delirium is often missed as the elderly patient is assumed to have dementia. Of note, the elderly patient with dementia is 90% more likely to have an episode of delirium in the hospital setting. Unfortunately, delirium is often unrecognized in the emergency room and intensive care units.
Avoiding Hazards through Advocacy and Presence
Preparation for a visit to the emergency department and a hospital admission can be found here. On admission, you or your parent’s designated Medical Power of Attorney, should be available to advocate for your parent. You, or any member of your family, will be the first to note any changes in your parents’ condition and may be the first to recognize delirium. Even if you’re not sure what’s different or why, letting the healthcare team know of your concern(s) will ensure they assess your parent accordingly.
Advocating for your parent requires attention to detail, speaking to all the physicians involved in your parents care, asking for updates from the nursing staff and ensuring care, treatments and studies ordered are provided. In general, if you think something isn’t right, if you believe your parent’s condition is worsening, speak up. Many hospitals have instituted rapid response teams that can be deployed by staff and family members. A family member can pick up the phone to ask the team to respond and evaluate their loved one. Look for information regarding these teams in your parent’s hospital room. If you don’t see any information ask the nurse about it.
Being present with your parent in the hospital reduces risk. He or she is less likely to fall if someone is at or near their side at all times. Try setting up a schedule that includes as many family members as possible; take turns. This way you can ensure your parent is never alone. Keep in mind that staying with your parent includes trips into the bathroom. Most hospitals require someone stay with the elderly in the bathroom to reduce falls. Not everyone will feel up for this challenge.
Staying with your parent during their entire hospital stay is rarely an option for anyone. Yet having someone stay with your parent is a successful strategy for reducing risk in the hospital. We weren’t able to be with my mother 24/7 while she was hospitalized. Unfortunately, she fell in the bathroom. Luckily she suffered only a few bumps and bruises. Many hospitals have teams of safety technicians, often referred to as “sitters,” that will stay at your parent’s bedside. This may be at no cost to you or your parent. Be sure to ask about this service.
Hazard Free Hospitalizations?
There can be no guarantee that your parent will avoid all possible hazards. However, it is possible to reduce risk. Be prepared for hospitalizations, speak up (as loud as necessary), and be present.