Report: Elderly Patients Leave Hospitals More Disabled Than When They Arrived

Adverse events cost Medicare billions of dollars

Many elderly patients deteriorate mentally or physically in the hospital, even if they recover from the original illness or injury that brought them there, according to an article posted on the Kaiser Health News (KHN) website. How hospitals handle the old—and very old—remains a pressing problem.

About one-third of patients over the age of 70 years and more than half of patients over 85 leave the hospital more disabled than when they arrived, research has shown. As a result, many seniors are unable to care for themselves after discharge and need assistance with daily activities, such as bathing, dressing, or even walking.

Elderly patients are a growing clientele for hospitals, a trend that will accelerate as “baby-boomers” age. Patients over 65 already make up more than one-third of all discharges, according to the federal government, and nearly 13 million seniors are hospitalized each year. And they stay longer than younger patients.

Hospital staff members often fail to feed older patients properly, get them out of bed enough, or control their pain adequately, according to the KHN article. Providers often restrict their movements by tethering them to beds with oxygen tanks and intravenous poles. Doctors subject them to unnecessary procedures and prescribe redundant or potentially harmful medications. And caregivers deprive them of sleep by placing them in noisy wards or checking vital signs at all hours of the night.

Interrupted sleep, unappetizing food, and days in bed may be merely annoying for younger patients, but they can cause lasting damage to older ones. Elderly patients are far different than their younger counterparts—so much so that some hospitals are treating some of them in separate medical units.

San Francisco General is one of them. Its Acute Care for Elders (ACE) ward, which opened in 2007, has special accommodations and a team of providers to address the unique needs of older patients. They focus less on the original diagnosis and more on how to get patients back home, living as independently as possible.

Such units are still rare—there are only about 200 around the country, KHN notes. And even where they exist, not every senior is admitted, in part because space is limited.

Hospitals face few consequences if elderly patients become more impaired or less functional during their stays, the article points out. The federal government penalizes hospitals when patients fall, develop preventable infections, or return to the hospital within 30 days of their discharge. But hospitals aren’t held accountable if elderly patients lose their memories or their ability to walk. As a result, most hospitals don’t measure those things, KHN says.

Although research on the financial impact of problematic hospital care for the elderly has been limited, a 2010 report by the Department of Health and Human Services’ Office of Inspector General found that more than 25% of hospitalized Medicare beneficiaries had experienced adverse events as a result of medical care. Those events, such as bedsores or oxygen deficiency, cost Medicare approximately $4.4 billion annually. Physicians who reviewed the incidents determined that 44% could have been prevented.

In addition to outright mistakes, poor or inadequate treatment in hospitals leads to needless medical spending on extended hospital visits, readmissions, in-home caregivers, and nursing home care. Nursing home stays cost approximately $85,000 a year. And the average hospital stay for an elderly person is $12,000, according to data from the Agency for Healthcare Research and Quality.

Source: Kaiser Health News; August 9, 2016.