Involving healthcare providers from different disciplines only enhances the care of geriatric patients. “Even though hospitalists may not have the depth of knowledge of geriatrics that a geriatrician has, they certainly have the knowledge of acute care medicine that we have, so they can manage the medical problems,” says Dr. Palmer. “What they need to do is think systematically, in a structured way, and to work collaboratively with key players. This only takes a few minutes each day, but more importantly, it saves time. You have fewer phone calls and fewer angry family members when you manage the care in a structured manner, working with a team of health professionals.”
Dr. Morley and his team have developed a form for their ACE unit that allows them to assess a patient’s status and goals in two to three minutes.
Dr. Pierluissi has experienced firsthand the benefits of working as a member of the interdisciplinary team. “Essentially,” he says, working in teams to treat the geriatric patient means there are “more heads in the game, more people trying to work in the patient’s best interest. You [the clinician] really do feel supported, and it makes your day more enjoyable and more productive.” TH
Gretchen Henkel is a medical journalist based in California.
- Kozak LJ, Hall MJ, Owings MF. Hospitalization fact sheet. In: National Hospital Discharge Survey: 2000 Annual summary with detailed diagnosis and procedure data. Hyattsville, Maryland: National Center for Health Statistics. Vital Health Stat. 2002;13(153).
- Covinsky KE, Palmer RM, Fortinsky RH, et al. Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc. 2003 Apr;51(4):451-458.
- Landefeld CS, Palmer RM, Kresevic DM, et al. A randomized trial of care in a hospital medical unit especially designed to improve the functional outcomes of acutely ill older patients. N Engl J Med. 1995 May;332(20):1338-1344. Comments in: ACP J Club. 1995 Nov-Dec; 123(3):69 and N Engl J Med. 1995 May 18; 332(20):1376-1378.
- Counsell SR, Holder CM, Liebenauer LL, et al. Effects of a multicomponent intervention on functional outcomes and process of care in hospitalized older patients: a randomized controlled trial of acute care for Elders (ACE) in a community hospital. J Am Geriatr Soc. 2000 Dec;48:1572-1581.
- Inouye SK, Bogardus ST Jr, Charpentier PA, et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med. 1999 Mar 4;340(9):669-676. Comments in: N Engl J Med. 1999 Jul 29; 341(5):369-370; author reply 370 and N Engl J Med. 1999 Mar 4; 340(9):720-721.
- Cohen HJ, Feussner JR, Weinberger M, et al. A controlled trial of inpatient and outpatient geriatric evaluation and management. N Engl J Med. 2002 Mar 21;346(12):905-912. Comments in: Curr Surg. 2004 May-Jun;61(3):266-274; N Engl J Med. 2002 Aug 1;347(5):371-373; author reply 371-373 & N Engl J Med. 2002 Mar 21;346(12):874.
- Naylor MD, Brooten DA, Campbell RL, et al. Transitional care of older adults hospitalized with heart failure: a randomized, controlled trial. J Am Geriatr Soc. 2004 May;52(5):675-684. Erratum in J Am Geriatr Soc. 2004 Jul; 52(7):1228. Comment in Evid Based Nurs. 2004 Oct;7(4):116.
- Palmer RM. Acute hospital care of the elderly: making a difference. Caring for the Hospitalized Elderly [special supplement to The Hospitalist]. 2004. Available at: www.hospitalmedicine.org/AM/Template.cfm?Section=The_Hospitalist&Template=/CM/ContentDisplay.cfm&ContentFileID=1447. Last accessed March 14, 2007.
- Wilson MM, Thomas DR, Rubenstein LZ, et al. Appetite assessment: simple appetite questionnaire predicts weight loss in community-dwelling adults and nursing home residents. Am J Clin Nutr. 2005 Nov;82(5):1074-1081.