Hospital care that covers all the bases
Date: June 1, 2012
As the number of geriatric patients steadily rises across the country—accounting for about one-third of all hospital admissions nationwide—hospitals and physicians have grown increasingly aware of the complications and risks that these patients face from long-term stays.
As a result, Howard County General Hospital recently adopted the Acute Care for Elders (ACE) program model, a nationwide effort aimed at improving geriatric hospital care and outcomes for elderly patients.
“Our main goal is to make sure that when elderly patients come through the hospital, they’re able to maintain function,” says hospitalist Anirudh Sridharan, medical director for the hospital’s ACE program. “A win for us is getting these patients back home at the same level of function with which they came to us.”
The program launched as a pilot last November and can accommodate 10 patients. To be eligible for the ACE program, a patient must be at least 70, admitted through the Emergency Department from home, and at risk for functional decline.
For hospitalized patients, the culprit behind functional decline is often immobility. Elderly patients may be admitted to the hospital and find themselves spending the majority of their stay in bed with little exercise or socialization, or perhaps adhering to an abnormal routine that includes middle-of-the-night blood pressure and heart rate checks or catheter changes.
“When any person lies in bed for longer than two days, they start to decondition,” says Francie Black, a nurse practitioner with the program. “Elderly patients lose muscle mass much more quickly than a 40-year-old and don’t have the capacity to bounce back as easily.”
The ACE model helps patients avoid inactivity and prevent other common risk factors associated with functional losses. Through physical therapy, pharmacy consultations, education, nutrition and high-quality nursing care, the hospital’s ACE team works with admitted patients to make sure that they remain active and well nourished, and that they have plenty of opportunities to exercise their bodies and minds.
Meanwhile, a special medical ordering system takes into account patients’ ages, so that physicians and other providers can remain cognizant of how certain treatments and therapies might negatively affect a person’s cognition or physical function. “As doctors, we need to make sure we’re not tying them down by not giving unnecessary oxygen, by removing catheters as soon as possible, and by making it easier for them to get around,” Sridharan explains.
Medicinal techniques aside, patients also are encouraged to socialize and exercise their minds. That includes eating meals out of bed and in a common area where they can mingle with other patients, play board games, complete crossword puzzles and so on.
“With aging brains, if they’re not exercised, they lose the capacity for simple math or keeping track of the day,” Black says. “We want our patients to function here much as they do at home.”
Since the program’s launch, patients have been receptive, Sridharan says, even those who might otherwise be inclined to sit still and recover in bed.
“In the past, there was this mentality that if you’re sick, you need bed rest,” he says. “But now we’re teaching people that’s not in their best interest. If you explain to patients that the longer they stay in bed, the weaker they become, they get it immediately.”