Hospitalization for seniors

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by Jennifer Jilks

If you, or someone you love, is hospitalized, you are at risk for many complications. The first is, of course, superbugs. However, if an elderly relative is put into hospital there are many things you can do to prevent these complications. There are new studies to demonstrate that post intensive care unit (ICU) care is crucial.

The elderly are at risk for a number of issues once hospitalized. These demand that family members get involved and be proactive as a friend or caregiver. You want to reduce stress, improve and maintain physical and cognitive function, reduce falls, and prevent admission to long term care while improving quality of life. Placement in a hospital may lead to poor nutrition, dehydration, immobilization, sleep deprivation and unnecessary medication. Myocardial infarction, pneumonia, and stroke are well recognzied complications of intensive care treatment.

The Aging Process

Be vigilant about all bodily functions. Hospital rest may increase stress and exacerbate the normal aging process. As we age, there are changes in our muscles,blood pressure, lung function, bone strength, and bladder control.  We naturally lose muscle mass, strength and energy. Joints tighten up, skin thins as skin cells are replaced more slowly, sometimes resulting in infections for “bed ridden” patients.  Appetite decreases, fractures immobilize us and we may experience lowered cognition. High or low blood pressure becomes a predictable risk, rib cages stiffen, dizziness may result from reduced oxygen to the blood, osteoporosis causes decreased bone strength. Poor nutrition is common, as is an inability to get to the bathroom.

Be Present

Hospitals are places for those acutely ill. They do not deal well with frailty. Expect that you will be of benefit to relatives if you are present at their bedsides. There is much to do. It is important to advocate for them: record treatment plans, medications, test results. Be proactive. As Why, How often and How much?  Ensure that relatives have all their senses available and provide them with glasses and hearing aids. Check that they are not unduly restrained, or overmedicated. Look at their medications. When you first go in to the hospital bring along all medications and determine if they are a) getting required medication, i.e. cholesterol, blood pressure meds.

 

Liquids and food   Make sure that your relatives are getting enough fluids and food.

Mobility

Ensure that patients are kept mobile. If they cannot walk, they can have physiotherapy, massage. Restraints should only be used if necessary. (They were in my Dad’s case. He fell out of his wheelchair all the time.) With insufficient physio, restraints, bladder catheters and bed rest we risk impaired mobility, which may lead to falls and difficulty with stair climbing.

Activities

Keep minds active by playing cards, reading aloud, looking at photo albums, playing board games. Create a memory album. Take in an iPod with family photos, favourite music, a stuffed animal.

Discharge

Do not permit relatives to be discharged if you cannot look after them, or if you have no plan for Home Care through Community Care Access Centre (CCAC). Ask for a referral to a geriatrician for a geriatric assessment before you take them home. A comprehensive assessment can identify and assess medical, psychological, environmental and social factors that contribute to frailty, dementia and delirium. Nutritional deficiency, lack of sunlight, and use of corticosteroids can all cause bone demineralization and vitamin D deficiency, so be vigilant.

Dementia

About 50% of those with dementia are at home. Of these, 2/3 of them remain undiagnosed.

It is estimated that dementia is present in:

* 23% of seniors aged 85-89
* 40% of seniors aged 90-94
* 55% of seniors aged 95-99
* 85% of seniors aged 100-106

Ensure that you know the difference between dementia and delirium. The latter is due to drug interactions, or infections and can be cured, but dementia may have serious implications for home care. Dad was discharged from emergency with delirium and became incontinent. He had a bladder infection from his radiation treatments and was in a bad way. Totally curable, but undiagnosed. It broke my heart.

Staying Out of Hospital

Of course, prevent hospitalization by eating well, staying active, exercising mind, body & spirit, and being informed about health risk factors through screening and immunizations.

Be Aware

Be vigilant and take note of new symptoms: confusion, falls, loss of independence, incontinence, depression. Create a visitors list, ask for help from the CCAC, Red Cross or respite care from non-profit institutions. Look for generalized weakness or fatigue, which mandates assessment for anemia, nutritional deficits, sleep disturbance, muscular deconditioning, medication adverse effects, and/or neurologic impairment.

If patients have a history of delirium, followed by prolonged sedation, mechanical ventilation, and acute respiratory distress syndrome, they are at risk psychologically: comorbidities may include posttraumatic stress disorder (PTSD), anxiety disorder, and depression. Families and caregivers may also feel depression and anxiety.

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Resources

  1. Prescription for Excellence: How Innovation is saving Canada’s Health Care System, by Michael Rachlis MD, Harper Collins 2004.
  2. Sharon K. Inouye et al. Delirium: A symptom of how hospital care is failing older persons and a window of opportunity to improve quality of hospital care. Am J Med 1999;106:565.
  3. John A. Rizzo et al. Multicomponent targeted intervention to prevent delirium in hospitalized older patients: What is the economic value? Medical Care 2001;39:740.
  4. Désirée Lie. MD. MSEd. Outpatient MAnagement of the Post-ICU Patient Review.
  5. Get Seniors Moving to Prevent Falls
  6. Primary source: Journal of the American Geriatrics Society
    Kenny RAM, et al “Summary of the updated American Geriatrics Society/British Geriatrics Society Clinical practice guideline for prevention of falls in older persons” J Am Geriatr Soc 2010; DOI:10.1111/j.1532-5415.2010.03234.x.

Jennifer Jilks hosts a public service health blog at http://ontarioseniors.blogspot.com