Geriatric hospital medicine

Admitting elderly patients to the hospital, supervising a successful course of treatment, and subsequently arranging for a safe and appropriate discharge placement can be complicated and time consuming. The primary challenge facing the clinician is that hospitalization for elderly persons is characterized by a complex set of benefits and burdens. On the positive side, a stay in the hospital can facilitate (1) intervention at a time of greatest need, (2) appropriate and timely treatment of acute medical problems, and (3) efficient evaluation of the health status of frail elderly patients. Conversely, however, hospital admission can become a critical life event for older adults, precipitating medical, social, care-giving, legal, financial, ethical, and emotional crises, which can interfere not only with recovery but also with successful return to previous living arrangements. Almost one third of older adults admitted to acute medical-surgical units leave the hospital with a new impairment in their functional status [1]. Because of the considerable risks and burdens associated with hospitalization for elderly individuals, it is imperative that every effort is made to ensure a positive outcome when an elderly patient is admitted to the acute care setting. This article is intended to assist the physician in accomplishing this goal. The geriatric population is remarkably heterogeneous, however, and general treatment recommendations and guidelines must be applied only in the context of the individual patient's biologic age, functional abilities, and cognitive status. In addition to treating the medical problem that precipitates the admission, the objectives of physicians who supervise the care of older hospitalized patients can be summarized as follows: 1. Conduct timely discussions with patient and family members, establish appropriate goals of care, and follow through and implement treatment based on these goals. 2. Intervene to maintain and/or improve the patient's functional status. 3. Identify patients at risk and initiate measures to prevent iatrogenic complications. 4. Work with the patient's health care team throughout the hospitalization to maximize function and to develop a safe, coordinated, appropriate discharge plan. 5. Recognize that hospitalization can be hazardous to the health of older adults and therefore do everything possible to minimize length of stay, without discharging the patient prematurely. This article covers the following: the demographics of hospitalization for elderly individuals, indications for admission, atypical presentation of common geriatric diseases, the hazards of hospitalization for elderly patients, competencies associated with quality hospital-based geriatric care, the importance of discharge planning and transitional care, and a discussion of specialized models of hospital geriatric care.