Approach to Acute Hospital Care

In the United States, adults aged 65 years and older are often admitted from emergency departments to hospitals with acute illness in the setting of underlying chronic conditions, functional deficits and disabilities, frailty, polypharmacy, and adverse sociodemographic and economic circumstances. These challenges place them at risk for hospital-associated disability and adverse post-acute-care outcomes. A comprehensive assessment by the admitting clinical provider and the interdisciplinary team identifies older adults at risk of adverse events related to hospitalization and optimizes clinical outcomes with patient-centered interventions. The team can employ screening tools to identify patients at risk for functional decline, delirium, immobility, and poor prognosis, and apply practical strategies to prioritize what matters to patients, to advance their mobility and mentation, and to assure the safe and appropriate use of medications. Communication between the clinical provider and the interdisciplinary team and patients and/or family surrogates daily includes whether there is a continued need for hospitalization, the estimated length of hospital stay, and the post-acute site of care consistent with the patient’s safety and preferences. This chapter describes a framework for healthcare providers to integrate the principles of comprehensive geriatric assessment with interdisciplinary and patient-centered care in order to minimize the hazards of hospitalization and optimize the health outcomes and care transitions of older adults.