Hospital care for older people

[Mary Mallozziberg]

More than one third of people admitted to the hospital are older people. And at any time, almost half of people in the hospital are 65 or older. Almost half of older people seen in an emergency department are admitted to the hospital.
When many older people leave the hospital, they may be in worse shape than before they became ill. Part of the reason for the decline is that older people tend to have longstanding serious and debilitating disorders when they enter the hospital. (See also Problems Due to Hospitalization.)
However, part of the reason is just being in a hospital, which can cause problems, regardless of age. Older people are more likely to already have or to develop these problems, and the consequences are more likely to be serious for the following reasons:

Confusion: Changes that occur as people age make them more likely to become suddenly and noticeably confused (delirious).
Dehydration: Older people tend to feel thirsty less quickly or less intensely than younger people. They thus are inclined to drink less, especially when circumstances make getting water more difficult, as occurs in a hospital.
Falls: Older people are more likely to fall and, if they fall, more likely to have a serious injury such as a broken bone.
Incontinence: Older people may have particular difficulty getting out of a high hospital bed after they have had surgery, when they have a serious disorder, or when they have various equipment attached to them. As a result, they may not get to a toilet in time.
Loss of independence: During a hospital stay, older people may become unable to take care of themselves because staff members provide this care (such as bathing).
Loss of muscle tissue: When they spend a lot of time in bed or are immobilized, older people tend to lose more muscle tissue and lose it more quickly.
Pressure sores: Older people are prone to pressure sores because they tend to have less fat under the skin and blood flow to the skin is decreased. If they develop pressures sores, they may be sent to a nursing home rather than their own home after they are discharged from the hospital.
Side effects of drugs: Before entering the hospital, many older people are taking several drugs. In the hospital, more drugs may be prescribed. The more drugs people take, the greater the chance for side effects and drug interactions. Also, older people are more sensitive to the effects of certain drugs.
Undernutrition: Physical age-related changes may reduce appetite or absorption of nutrients, as may certain disorders (including dental problems) and drugs.

Many older people have difficulty bouncing back psychologically and physically from the experience of being in a hospital as well as from the disorder they have had.