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In a recent article in the San Francisco Chronicle, Dr. Edgar Pierluissi brings to light an issue that many people are unaware of. It is an interesting “paradox” as Pierluissi puts it that seniors can be in no better place than a hospital for identifying, treating and monitoring illnesses, but that hospitalization “accounts for about half of all new-onset disability and worsening of existing physical disability in people older than 70.” The onset of disability or worsening of existing conditions is called “Hospitalization-Associated Disability.” <img alt=”elderinhospital.jpeg” src=”http://www.nursinghomeabuselawyerblog.com/elderinhospital.jpeg” width=”275″ height=”183″ align=”left” hspace=”10″ vspace=”10″ /
Causes of Hospitalization-Associated Disability
Elderly patients encounter numerous hazards during hospitalization.There are physical hazards such as bed or pressure sores, adverse drug reactions, and bowel or bladder dysfunction. Psychological hazards include confusion and depression. These hazards alone or combined can contribute to new or increased disability and a loss of independence according to Pierlussi. Doctors, patients, and relatives fear that an individual enters the hospital for treatment of an illness, but leaves disabled and no longer able to live alone.
Many elderly patients are unable to exercise in hospitals either due to the illness or due to existing disabilities. Other patients are unable to exercise because they were put on bed rest by their doctor. This lack of exercise leads to a rapid loss of muscle strength for people over the age of 70. The article in the Chronicle states that patients over the age of 70 “lose more than 15% of their muscle strength with 10 days of bed rest.”
This is an alarming statistic. Hospitalization-associated disability sets in quickly and can have a devastating impact.
A.C.E. stands for Acute Care for Elders. San Francisco General Hospital adopted A.C.E. as a way to prevent hospitalization-associated disability in elderly patients. There are four basic features to the ACE approach as outlined by Pierlussi:
(1) Interior designs that make hospital units easier for older adults to use
(2) Patient centered care
(3) Early planning for discharge
(4) Careful daily review of medications and procedures
Pierlussi points out that the “heart of the program” is feature (2); Patient centered care. San Francisco General uses teams of providers consisting of therapists, doctors, pharmacists, dieticians, social workers and nurses to assess and assist the patients in a number of ways. The rehab therapists make sure patients are exercising in one way or another. The pharmacists work to make sure the correct medications and dosages are being administered while the dieticians ensure that patients receive a healthy diet while hospitalized. These same team members also work to establish goals for each patient to keep the patients psychologically engaged and to monitor progress. The care goes beyond the hospital since the team also develops a post hospitalization plan for each patient. ACE has worked to send more patients home rather than directly to nursing facilities; a chief concern for this program.
Where to go from here?
Our elder neglect attorneys are always looking for ways to help educate elders and their loved ones on ways to avoid mental and physical disabilities that can result from neglect or abuse. Every hospital does not have an ACE unit. The article points out and we agree that patients and their loved ones can take actions similar to that of an ACE unit. Patients and their families should take an active role in discussing the hospital’s plans for performing tests, administering meds, monitoring progress and crafting a plan for post discharge. Family members should help patients feel more at ease or at home in the hospital to help minimize the mental strain a foreign surrounding creates. Family members need to understand the dangers faced by newly discharged patients.
It is important to prevent a patient from developing new disabilities or from losing a sense of independence while hospitalized and then later when recovering at home. At this later stage of life, physical and mental disabilities can become permanent much more quickly than in earlier stages.
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