Hospitalists Prevent Elderly From Developing Disabilities

Marcia Frellick

March 11, 2016

 

SAN DIEGO — Internationally known geriatric specialist Rosanne Leipzig, MD, PhD, began her talk here at the Society of Hospital Medicine 2016 Annual Meeting by asking what percentage of patients age 70 years and older is discharged from the hospital with an "activities of daily living" disability that they did not have at admission?

Dr Rosanne Leipzig

Only half the audience guessed that the correct answer is 30% to 45%.

"These are not people who stroked. These are not people who had hip fractures. These are people who came in with pneumonia, congestive heart failure, urinary sepsis. Somehow that got better but their function did not," said Dr Leipzig, who is a professor at the Mount Sinai School of Medicine in New York City.

She described several practices that can help prevent harm and improve care.

Know your patient's baseline function. This is not the function level when they come into the hospital, but the level weeks before, Dr Leipzig explained. Ask the family how the patient was in the weeks before admission.

Get your patient moving. "Bed rest is for dead people. You have lower pain scores, less swelling, and less post-thrombotic syndrome," she pointed out.

Educate the patient and family on the risk of falling in the hospital. Patients in the hospital are weaker than they are at home, on more medication, and in an unfamiliar place, but "they don't get that they're at higher risk," she said. They should be coached on safe clothing and the need to ask for, and then wait for, help.

Get rid of the tethers. "People do not have to have an IV in place to be in the hospital. If they can get what they need without the IV, that's great. If they can get a hep-lock, so they're not tethered, that's even better," Dr Leipzig said. Tethers increase the risk for falls.

Assess daily for delirium. "If you're told that someone has altered mental status or agitation, assume it is delirium until proven otherwise. We so often accept such wide variation in behavior as being normal," she pointed out.

Know that the medication effect is greater with age. "As we get older, we're more fat and less water." Just as alcohol tolerance decreases with age, "this can go for any medication you're taking. You get more bang for the buck. Oftentimes, older people don't need the larger doses to get the effect you're looking for," she said.

Know your patient's estimated glomerular filtration rate. Recognize that a normal creatinine level is not the same as a normal kidney function. Creatinine reflects muscle mass, which decreases with age; therefore, it takes more kidney disease before the creatinine will increase. Age and weight are taken into account when the rate is used to estimate kidney function, she explained.

The hospitalist holds the keys to preventing elderly patients from developing functional disabilities in the hospital, Dr Leipzig told Medscape Medical News. Get patients out of bed, monitor their food and water intake, and carefully consider the type of medications they are taking, and the doses.

She said she urges the Goldilocks approach in prescribing: "Not too much, not too little. Just enough."

Dr Leipzig has disclosed no relevant financial relationships.

Society of Hospital Medicine 2016 Annual Meeting. Presented March 8, 2016.

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