Hospitals can be hazardous environments for older adults

Elderly patients are much more vulnerable to the various insults associated with hospitalization compared to their younger counterparts. Some common adverse events we see in hospitalized elders include: functional decline, delirium, undernutrition, and polypharmacy.¹ It is estimated that 1 in 7 older adults experience an adverse event during their hospital stay.¹ 27% of these patients end up going on to develop multiple related adverse events.¹ Many of these patients have a hard time recovering after they have been hit with the insults associated with hospitalization.

How are we dealing with this?

Over the past decade, hospitals in Canada have been trying to adapt their models of care to become more tailored to the needs of older adults. This is surfacing through the formation of a specialized hospital unit for geriatric patients called the Acute Care for Elders (ACE) unit. ACE units focus on “recognizing the needs of acutely ill older patients and modifying common medical practices and standards to best meet these needs.”⁴

ACE hospital units have been shown to have many positive effects for both the hospital and the patient, including reduced costs, decreased length of stay, improvement in functional abilities, decreased need for antipsychotic drug use, reduced duration of urinary catheter use, reduced hospital readmissions, and reduced adverse events related to hospitalization.²

Where does the pharmacist fit in?

A substantial number of hospitalizations among the elderly are attributable to medications. Almost 50% of older adults who take five or more medications have been hospitalized as a result of adverse drug events, errors related to taking the wrong medication, the wrong dose of medication, or interactions between medications³. Most of these adverse events are preventable.³ Pharmacists can play a role in preventing hospital admissions by ensuring safe and efficacious medication use, promoting adherence, assessing for drug interactions and adverse drug reactions, and by providing appropriate discharge counselling so patients know what new medications they are starting and what old ones they are stopping after a hospital admission.

As the role of a pharmacist expands, physicians and patients will rely more and more on pharmacists to optimize medication management for the elderly, both in hospital and in the community. The bottom line is that there is a huge role for pharmacists to play in helping to keep older adults away from the threats of the hazardous hospital environment.

References

1. Today’s geriatric medicine. (2015). ACE unit improve complex patient management. Retrieved from: http://www.todaysgeriatricmedicine.com/archive/090913p28.shtml
2. Physicians Weekly. (2013). Analyzing the effect of ACE units for older people. Retrieved from: http://www.physiciansweekly.com/acute-care-for-older-patients/  
3. Healthy Debate. (2014). Improving medication safety for the elderly. Retrieved from: http://healthydebate.ca/2014/12/topic/managing-chronic-diseases/medication-safety  
4. Accreditation Canada. (2013). Acute care for elders (ACE) unit – medicine. Retrieved from: https://www.accreditation.ca/acute-care-elders-ace-unit-%E2%80%93-medicine