Most medical professionals agree that staying healthy enough to avoid a hospital stay should be a senior’s ultimate goal. Whether an older adult is going into the hospital for the first time or is facing a re-admission, a hospital stay can be bad news.
Professionals who work with seniors have likely observed that older adults who are hospitalized sometimes don’t go home the same. Or, they don’t go home at all.
Several potential risks or aftereffects of hospitalization could hit seniors particularly hard, according to a survey of 400 North American nurses who specialize in senior care and conducted by Home Instead, Inc., franchisor of the Home Instead Senior Care® network. Leading the list is hospital-acquired infections followed by difficulty getting back into a routine, more health declines, confusion and inability to regain full function.
Dr. Carolyn Clevenger from Emory University, president-elect of the Gerontological Advanced Practice Nurses Association (GAPNA), explains how the potential issues surrounding hospitalization can jeopardize the health of older adults.
"Even if you’re well, the human body experiences normal age-related changes. There’s a decrease in circulation and loss of muscle. Add to that hospitalization, which can include complete bed rest. A cascade of things can happen, which are universally negative and could lead to nursing home placement,” she noted.
There are several reasons why readmissions may occur.
• Patients may be discharged without understanding their illnesses.
• Patients with chronic conditions may pose a particular challenge.
Medication mismanagement is one of the leading problems that can send a senior back to the hospital. In fact, according to the Centers for Disease Control and Prevention, adverse drug events cause over 700,000 emergency department visits each year and nearly 120,000 of those patients are hospitalized for further treatment.
Sometimes individuals inadvertently discontinue important medicines needed to stay well. Some seniors may not have the right prescriptions or be able to fill them. Sometimes there is confusion. Maybe a medication is changed in the hospital and the family physician is unaware of this and prescribes another medication that conflicts with that medication. Another communication challenge is that patients can become confused when medications are changed and the change is not clearly explained.
• Another driver of readmission is that family members are frequently not included in discharge planning, even though they may be the central caregiver.
• Coordination and communication are important drivers: sometimes the physicians caring for the senior do not communicate with each other and fail to develop a coordinated plan for post-discharge care.
• Lack of coordination: Sometimes individuals are too embarrassed to say they do not understand the directions they are given.
Preparing for discharge helps alleviate readmissions.
• To help the family prepare for the transition home, asking questions and understanding the situation is a crucial step.
• Getting prepared begins with asking a lot of questions. In consultation with your loved one’s medical providers, try to determine your loved one’s:
– length of stay and extent of illness
– what he or she will or won’t be able to do
– dietary concerns
Medical equipment needed, follow-up care required, warning signs, and help needed both for the short- and long-term are things you may need to know and discuss with your loved one’s medical professional. You might also want to inquire about insurance coverage and where to find the resources you need. Once you have this information you can begin to make all of the necessary preparations for your loved one’s return home.
The first few days back at home are the most critical. This is when you’ll need to watch for warning signs. It’s also a good idea to keep a daily record of medications taken, meals eaten, activities undertaken and assistance provided. It’s important for caregivers during the first 30 days to make sure the senior keeps all follow-up doctor and rehab appointments. It is also very important to make sure medications are refilled, plenty of healthy food is stocked in the home, safety improvements are made in the home when necessary, arrangements have been made for follow-up appointment and that any medications that are no longer needed are discarded appropriately.
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