EDITOR’S NOTE: Third in an occasional series of reviews of the Hospital Medicine: Current Concepts series by members of Team Hospitalist.
Older patients comprise an increasingly large part of the population we serve as hospitalists. We are all very familiar with the standard medical problems—congestive heart failure, COPD, or stroke—that these individuals present to us in the inpatient setting; however, this patient population has special needs and challenges that often are inadequately covered in textbooks and treatment guidelines.
The Hospitalists’ Guide to the Care of Older Patients serves as an excellent guide for the day-to-day management of geriatric patients. All 13 of its chapters are written in a concise, to-the-point style. The authors have a sound understanding of the needs and challenges of today’s practicing hospitalists.
The authors focus entire chapters on geriatric assessment and exam and communication with older patients. They remind hospitalists to be aware that these patients need a thoughtful approach in our interactions, because vision, hearing, or cognition might be impaired.
The 269-page book provides a great overview on decision making and decision-making capacity (DMC). Patients might have partial DMC, in spite of cognitive impairment or neurological or psychiatric illness. Surrogate decision makers and their limitations also are discussed.
One chapter is dedicated to end-of-life care, with special attention to debility and dementia.
Another major focus is geriatric pharmacotherapy and polypharmacy in the elderly. Attention is given to the fact that drug studies frequently fail to include the elderly and that pharmacokinetics may be significantly altered in this population. The chapter includes a table of “high-risk meds” prescribed by hospitalists.
Delirium and management of behavioral disturbances are described in two chapters and include very helpful tables to guide in its treatment.
The authors also review nutrition management, including a customized approach to patients with dysphagia at risk for aspiration and managing complex medical patients with hip fractures, including pre-op evaluation, post-op care, pain management, and delirium. Narcotic pain medications are of obvious concern in the elderly, but it is pointed out that uncontrolled pain in itself can cause delirium.
Special attention is given to mobility and fall risk, as well as prevention strategies, in hospitalized patients.
Pressure ulcers are a concern in all patients but especially the elderly. This guide outlines mechanisms of ulcer formation, staging, and treatment options.
The book concludes with a chapter on transitional care planning for a safe discharge. It describes potential risks for errors and poor handoffs, including failure to adequately communicate complex discharge plans to elderly patients.
The Hospitalists’ Guide to the Care of Older Patients is an excellent, hands-on manual for managing elderly patients. It describes standard situations frequently encountered by hospitalists and provides pertinent information that can be acted upon.
Written with a genuine understanding of what matters most for hospitalists in their daily practice, the chapters are focused and concise enough to serve as a quick reference, yet detailed enough to supply the hospitalist with sufficient information to be able to put a patient management plan into action.
After reading this book, hospitalists will have a solid and rational basis for the thoughtful and effective management of elderly patients.
Dr. Suehler is a hospitalist with Midwest Internal Medicine Hospitalists at Mercy Hospital in Coon Rapids, Minn., and a member of Team Hospitalist since 2013.