When an elderly person is admitted to the hospital, Adrienne Green, MD, sees an opportunity for something beyond addressing the medical issues at hand.
“One of the key issues that is important for practical, everyday care is trying to figure out how the elderly are not functioning well at home,” says Dr. Green, an associate clinical professor of medicine at the University of California at San Francisco and a member of UCSF’s hospitalist group. “I think we do a great job of managing their diseases, but what we don’t do very well is helping them out with other things [such as coping with] their losses and the fact that they may be just barely hanging on at home in terms of their ability to care for themselves; and this hospitalization may really have set them back.”
Eva Chittenden, MD, an assistant clinical professor of medicine, also at UCSF, agrees. “Many hospitalists are so focused on the hospital that they’re not thinking about the ‘before the hospital’ and the ‘after the hospital,’” she says.
But after identifying the challenges that elderly patients face, communication itself may be challenging. Elderly individuals struggle with issues of control and allowing people to tell them what they need to change in their lives may not be an easy task. What are the best ways to communicate with hospitalized elderly patients to facilitate the best “whole-person” care?
When you bring an older person who already has a heightened sensitivity toward losing control into the hospital—this complex, technological world of medicine—and they have the cumulative disadvantage of being sick, it’s important to remember that there will probably be no other state that they’ll be in … where they will feel so out of control.
—David Solie, MS, PA
Under the Radar Screen
The hospitalists interviewed for this article agreed that getting a broader picture of an elderly patient’s health and well-being involves discovering how they are really doing at home. Dr. Green asks simple questions, particularly about activities of daily living, such as whether they’re doing their own shopping and cooking. She also involves the family, “because very frequently the patient will say, ‘I’m doing fine,’ and the family member is in the background shaking their head.”
She also looks for clues about whether the patient needs more help at home, whether they are compliant with their medications, and if not, why (e.g., can they open their medicine bottles)?
“I frequently have the elderly patients evaluated for home care just to get someone into their house … ,” says Dr. Green. “I think that probably 80% of our patients who are over 80 who come into the hospital have things in their homes that are not safe, such as throw rugs.” Even if patients are basically doing OK, “if I can get some home care for them, I know we’ll uncover a ton [of things that can be improved],” she says. “These patients may have … kind of snuck under the radar screen of their families and their primary [care physician], and I think the hospitalization kind of opens that up in some ways.”
Even if issues are uncovered by means of interviews and home-health visits, however, many elderly patients present a particular communication challenge. This, says David Solie, MS, PA, author of How to Say It to Seniors: Closing the Communication Gap with Our Elders, is because of the difference in circumstances and current experiences between the elderly and their hospitalist providers.1 It is common knowledge that younger people go through stages of development, but the elderly do, too, says Solie, who is medical director and CEO of Second Opinion Insurance Services in Woodland Hills, Calif., a brokerage that specializes in the insurance needs of impaired-risk, elderly individuals.