10 Things Geriatricians Want Hospitalists to Know

The Hospitalist. 2015 October;2015(10):

October 6, 2015 | The Hospitalist

8 Focus care on the patient as a whole, and on individual goals for treatment.

Dr. Covinsky urges hospitalists to treat not just the disease but the whole patient.

“Guidelines might recommend treating high blood pressure aggressively, but if the medications make a patient dizzy to the point of falling and risking a hip fracture, that treatment is not best for the patient as a whole,” he says.

He points out that each elderly patient has different levels of physical and cognitive impairment as well as psychosocial needs. Will they be returning home, and if so, what activities will they need to perform? How much support from caregivers will there be?

“It is essential that physicians understand at what level a patient was functioning when they entered, what happened at the time of hospitalization, and what their functioning needs will be when they go home.” Dr. Covinsky says.

9 Mobilize community supports to help the transition from the hospital to home, nursing facility, or hospice.

A corollary to treating the whole patient is the quality of transitional care. If you understand what a patient will experience when they leave the hospital, you will be better able to smooth out those transitions. Dr. McCormick encourages hospitalists to “learn about how nursing homes, home health agencies, and hospices work.

“Many hospitalists function in more than one setting,” he adds. “In addition to their practice in a hospital, they may be medical directors of nursing homes or hospices. These physicians are key agents of change who can offer guidance to hospitalists in ensuring flawless transitions between hospital and post-discharge living, which is often a predictor of successful post-hospitalization functioning.”

10 Become familiar with models of care for the elderly.

Dr. Covinsky points to the success elderly models of care have achieved in coordinating care and maintaining physical and cognitive function. ACE units, distinct areas of a hospital designed with the unique challenges of the elderly in mind, promote physical and cognitive function and help reduce the risk of delirium (see “The Acute Care for Elders (ACE) Unit: Successful Geriatric Care,” below).

Despite their demonstrated success, these models are not yet the standard of care for geriatric patients in most institutions. Hospitalists have the opportunity to be catalysts for the adoption of these effective approaches to geriatric care.^4,5

Maybelle Cowan-Lincoln is a freelance writer in New Jersey.

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The Acute Care for Elders (ACE) Unit: Successful Geriatric Care

The geriatric population experiences a higher occurrence of multi-morbidities and medical complexities. Many elderly patients suffer from geriatric syndromes such as cognitive and functional decline. The purpose of the ACE unit care model is to combat these challenges by proactively identifying and managing geriatric syndromes in order to help maintain the patient’s function.⁶

In addition to interdisciplinary care, hallmarks of ACE units include patient-centered, as opposed to disease-centered, care; transition planning from the beginning of a patient’s stay; and involvement of the patient and all caregivers from physicians to family in the care plan.

ACE units are distinguished by interdisciplinary teams usually consisting of a geriatrician, a nurse coordinator, nurses, physical and occupational therapists, pharmacists, dieticians, and social workers who jointly make rounds each weekday. These teams collaboratively develop a holistic, patient-centered care plan. In addition to interdisciplinary care, hallmarks of ACE units include patient-centered, as opposed to disease-centered, care; transition planning from the beginning of a patient’s stay; and involvement of the patient and all caregivers from physicians to family in the care plan.⁷

ACE units physically differ from regular medical units as well. Environmental modifications such as handrails in patient rooms and bathrooms, as well as in the hallway, promote safe mobility; contrasting colors aid people with vision loss. These units strive to create a homelike atmosphere, providing common rooms where patients can gather to socialize and engage in cognitive stimulation and therapeutic activities.