Hospital Units Tailored To Older Patients Can Help Prevent Decline
AUDIE CORNISH, HOST:
Hospitals can be difficult and dangerous for elderly patients. Even if they recover from what sent them to the hospital in the first place, a third of patients over 70 become disabled during their stay. That's why some hospitals are designing special units just for older patients. Anna Gorman reports from San Francisco.
ANNA GORMAN, BYLINE: A hospital is a terrible place to get a good night's sleep. Seventy-five-year-old Janet Prochazka was repeatedly woken up to get her vitals checked and blood taken. She was sick of it.
JANET PROCHAZKA: I wanted to be left alone. It was in the nighttime, of course. So I put the blanket over my head.
GORMAN: Prochazka had come to San Francisco General Hospital after a fall. Doctors treated her wounds and gave her medication for pneumonia, but she got worse. Time in the intensive care unit left her confused. She got weak from lack of sleep and exercise. Then she got a stomach infection.
PROCHAZKA: I really felt like I'd been dealt a blow I didn't need because I was really getting much better, and then all of a sudden, wham.
PROCHAZKA: Interrupted sleep, unappetising food and days in bed are frustrating for anyone. But for older patients, even short hospital stays can cause lasting harm. Ken Covinsky is a geriatrician at the University of California, San Francisco.
KEN COVINSKY: The older you are, the worse the hospital is for you.
GORMAN: Covinsky says doctors often prescribe medicine that's unnecessary or inappropriate for older patients. They also frequently leave in catheters or IVs too long.
COVINSKY: A lot of the stuff we do in medicine does more harm than good. And you know, sometimes with care of older people, less is more.
GORMAN: Covinsky says part of the problem is accountability. Hospitals face penalties from the federal government when patients fall or get bedsores, but there's no mandate to return patients home the same way they were before, physically or mentally.
UNIDENTIFIED WOMAN: Ice packs for eight bed one (ph).
GORMAN: When I met Prochazka, she'd already been at the hospital for more than a week. After those unpleasant days in the ICU, she was moved to a special unit designed for seniors. It's called Acute Care for Elders. There are about 200 similar wards in hospitals around the nation. Dr. Edgar Pierliussi shows me around. He points out special floors to reduce glare and a dining room where patients can eat their meals together.
EDGAR PIERLIUSSI: We do try to make things a little more homelike as much as one can in a hospital.
GORMAN: The geriatric wards try to get patients back home as quickly and independently as possible. To do that, they do common sense things like making sure patients sleep well and get up and move around.
PIERLIUSSI: They seem like small things, but they're as important as getting the primary diagnosis right.
GORMAN: The heart of the unit is the team, which includes a doctor, a nurse, a pharmacist and a social worker. They meet daily to make a plan for each patient. Today Nurse Annelie Nilsson gives an update on Prochazka.
ANNELIE NILSSON: She needs a little bit of rehab, but she's doing so much better transferring and walking.
GORMAN: But Nilsson says she's concerned because her patient is still confused and using a walker. Sitting in her hospital bed, Prochazka says she's worried, too, about staying independent when she gets out. She was living on her own and working as a special ed tutor until her fall.
So Nillson works with Prochazka daily to keep her mind and body active. They walk around the room and talk about family and pets, and I ask, do you feel as strong as you were before?
PROCHAZKA: Not quite, but I also feel like I'm getting there.
GORMAN: UC San Francisco's Covinsky says hospitals need to start paying closer attention to how their older patients fare.
COVINSKY: With an aging population, as we have more people in the hospital, this problem of hospital disability is going to increase unless we figure out how to fix it.
GORMAN: He says special geriatric units like this one should be part of the solution. I'm Anna Gorman in San Francisco.
CORNISH: Anna Gorman is with Kaiser Health News.
NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.