Senior Health: Hospitals Are No Place For Older People

Relatives and staff nurses in care facilities alike all express feelings of dismay and displeasure when their loved ones are sent home after emergency room visits, rather than being admitted to the hospital. I’ve been in that situation both as a staff member and as a relative, but inconvenient as it may be, there is a reason why hospital admissions are avoided whenever possible.

You already know that your loved ones are often the worse for wear after being discharged from the hospital.  Despite physical therapy efforts and discharge planning oversight, the likelihood of being able to resume independent activities immediately after discharge are small.  Don’t be too hard on those hard-working emergency doctors or the social service discharge planners, because they are right in believing that hospitals are no place for older people.

Mark Lachs, M.D. in his book “Treat Me, Not My Age,” gives a believable description about what happens to older people when admitted to the hospital.  They return home just a shell of their former selves.  Everything they do in the hospital is geared toward curing the malady as quickly as possible, but the patient often gets lost in the shuffle.   On discharge your parent is often confused, disorientated, weak, incontinent and suffering from all sorts of indignities.  Why does this happen?  They received their medicine, they spend hours in bed, and had meals served in their room.  All of these treatments sound quite wonderful don’t you think?  Like a vacation.  So what happens?

•  They put you to bed.  Forcing immobility on a person is a bad idea.  Your mom was right when she made you get up, bath, and get dressed even when you thought you were on deaths door.  Bed rest wastes your muscles, causes blood and other fluids to redistribute and may result in dizziness, balance problems and even pressure sores.

• They keep waking you up.  Sleep deprivation is thought to play a significant role in an acute confusional state.
• Since they keep waking you up, to see if you are okay, they offer you a sleeping pill or pain medications.  This creates a huge potential for drug interactions and adverse side effects.
• The catheter. Sometimes catheters are necessary but if used for staff convenience because they don’t have time to take you to the bathroom or change a wet bed, a host of problems can ensue.  The risk of infection can also contribute to long term or indefinite incontinence.
• Adult briefs for occasional accidents can lead to a lifetime of not being able to get to the bathroom in time for bowel or bladder necessities. You may be cured of whatever it was that you were hospitalized for, but you will need long term care because of incontinence issues.
• Sensory deprivation.  When you are admitted to the hospital you must leave all that is dear to you at home.  The absence of these things can contribute to the confusion and boredom experienced by many hospital patients.
• Hospital food.  While it has improved dramatically it is not the food you are used to eating.  If you are fighting an acute illness you would be better served eating foods that you actually like than not eating at all.

I have great respect for hospital staff, they love you and they care for you to the best of their abilities, but they are caring for the disease and not for you.  No matter what they say, you will always be “the gallbladder in 404”.   In short, the hospital is a place where your normal routine (mobility, nutrition, sleep, elimination, and access to creature comforts) get disturbed, and this can be devastating for older people.

The moral of the story is that you shouldn’t be upset or angry when your doctor refuses to give into your request for hospitalization.  Take your mom home or hire a personal caretaker.  Provide nutritious meals for a few weeks and spend as much time with her as possible. Her doctor will order Home Health Nurses and Physical Therapy if needed to facilitate an optimal outcome.  In the long run a few weeks of home care will be less expensive and the results will be much more rewarding than an admission to the hospital.

 

 

 

 

Comments

[jan]

great site. I love the unusual subjects you describe so profoundly. Succes.

oh, yes catheters are no good and indeed hospital stays should be as short as possible