For elderly patients, hospital environment can do more harm than good

Hospitals must address environmental factors that leave many patients at risk of long-term damage from post-hospital syndrome and delirium, according to a column in Forbes.

Hospital patients, who are already weak, must cope with a hospital environment that typically features frequent interruptions, bright lights and poor coordination due to drug treatments, writes Robert Pearl, M.D., CEO of the Permanente Medical Group. As the population ages, the average patient becomes increasingly susceptible to these issues, making the search for solutions even more urgent.

Delirium, which affects up to half of all elderly patients and as much as 85 percent of intensive care unit patients, can double a patient's risk of death within a year of hospitalization, according to Pearl. However, he writes, up to 60 percent of cases go unrecognized, many are misdiagnosed as dementia. Extended hospital stays due to delirium cost Medicare $164 billion a year, according to Pearl.

Post-hospital syndrome has long been a problem, but Harlan Krumholz, M.D., of the Yale School of Medicine coined the term only two years ago. It refers to patients' vulnerability in the days and weeks after leaving the hospital. The healthcare industry and the federal government are both aware of the readmissions problem, but of the nearly 20 percent of patients older than 65 readmitted within 30 days of discharge, two-thirds are readmitted for a different condition than the one that caused their hospitalization.

Part of the reason, Pearl writes, is the major disruptions in routine caused by a hospital stay, and how vulnerable seniors are to such disruptions. For example, he says 65 percent of patients older than 65 develop weakness in their legs and dizziness while standing within 48 hours of admission, and of those, 1 in 3 will never walk again after discharge.

Fixing these problems will take a structured, standardized approach and multi-disciplinary teams, Pearl writes. Not only must hospitals train staff to recognize and manage these conditions, they must also identify the most at-risk patients and take steps to safeguard their health, such as maximizing caloric intake; limiting blood-drawing whenever possible; synchronizing hospital lighting and noise with patients' internal clocks; and managing pain with non-sedating, non-opioid medicine whenever possible.

To learn more:
- read the column