What are the three main preventable reasons elderly get hospitalized?
There are three primary reasons the elderly are taken to hospital ER; falls, dehydration, and medication errors. In the past month I have attended two Conferences, one in the U.S, and the other in Canada. The aforementioned have been cited as the top three preventable reasons elderly are hospitalized. The cost of hospital care, ensuing complications, and even death from these conditions within the first six months are grim. Awareness and education for the elderly and their families could prevent hospitalizations due to falls, dehydration and medication errors.
According to the CDC, falls are the leading cause of both fatal and nonfatal injuries amongst the elderly. “In 2012, the direct medical costs of falls, adjusted for inflation, were $30 billion
According to government estimates, each year in the United States more than 125,000 people die from a failure to properly take their medications, adding approximately $100 billion in preventable additional hospitalization, emergency room, and repeat physician visit costs to the health care system.” In 1999, a study conducted in the United States evaluating the avoidable costs of hospitalizations due to dehydration was at $1.14 billion.
Why do these incidents cause so many problems?
The conferences I recently attended considered multiple reasons for falls among the elderly. The factors contributing to falls included inadequate lighting at night, medication such as tranquilizers, sleep medication, and antihypertensive meds, improper or lack of using a mobility device, and analysis of the procedure of getting out of the bed and how that contributes to falls.
Dehydration is common with the elderly because they do not drink enough water or fluids. Many consider consumption of tea or coffee as meeting the body’s hydration needs, but the caffeine in these fluids acts as a diuretic, contributing to dehydration. Often the elderly refrain from consuming liquids for fear of incontinence especially when having to leave home for appointments. Public bathrooms are not easily accessible. Even when at home the elderly do not feel the urge to drink fluids. The elderly are often on multiple medications that cause increased excretion of fluids, and in combination with a lack of fluid intake, their output is greater than their intake. Hence they quickly become dehydrated, which can also become another reason for dizziness resulting in falls.
Confusion about medication could easily be prevented if someone took the time to explain and review all medications the elderly are taking. Upon discharge home from the hospital, many seniors lack understanding on their regimen of medications. Review and instruction of medication needs to occur the same day the elderly person arrives home. More than half of post hospital discharge instructions are forgotten. A transitional care management nurse that visits the day of discharge will ensure medications are correctly set up and understood by the elderly person.
Are there solutions to decreasing hospitalization from falls, dehydration and medication errors?
Yes and they include collaboration between the senior, family caregiver, and transition care nurse prior to discharge home from the hospital. Simple instructions with supervision or assistance of family caregiver, or a home care nurse will ensure the senior takes the appropriate medication, the home environment is safe, and that there are adequate liquids in the home for drinking.
Ensure that medical equipment and mobility devices are at the home upon discharge from the hospital, and that the senior knows how to safely use them.
As a non-medical home care agency, AA Care Services provides a transition care nurse upon discharge to assist with reviewing all post hospital discharge orders. The agency nurse will perform an assessment of risk factors including falls, medication errors, and dehydration. A caregiver can assist and supervise all personal care and mobility needs of the senior, until the senior is feeling stronger and has regained their independence. These services are often short term, and will certainly help prevent hospitalization from falls, medication errors, and dehydration.
Want to find out more?
The National Private Care Association’s 2014 Annual Conference
Hyatt Regency y Grand Cypress
October 1-3, 2014
Centers for Disease Control and Prevention
Falls Among Older Adults: An Overview
Today’s Geriatric Medicine
Defeating Dehydration — Patient Monitoring Is Key
British Journal of Clinical Pharmacology Jun 2009; 67(6): 641-645
Medication errors in elderly people: contributing factors and future perspectives
Helen Trowsdale, President of AA Care Services, is a nurse administrator with over 30 years of experience as a BSN, psychiatric nurse, and geriatric care manager with adults as well as pediatrics in hospitals, private duty home health care agencies, and residential home health care. Her team of caregivers are dedicated to serving their clients with home care in San Antonio, New Braunfels, and Austin; providing clients with consistent, quality care while minimizing the number of caregivers in the home. Learn more about AA Care Services.