hospitalization

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Epidemiology

  • adults >= 65 years of age comprise 13% of the population, account for 36% of hospitalizations, & 50% of hospital costs
  • hospitalized elderly with lower risk of mortality (11.1% vs 11.5%) when treated by female internist rather than male internist[20]
  • older patients triaged in the emergency department as less urgent or not urgent, are much more likely than younger patients to be admitted at the initial presentation (5% vs 0.6%) or over the next 14 days (4% vs. 0.7%)
    • the oldest patients (>85 years) were most likely to be admitted (9% vs 2% of those aged 65-74 years)[27]
  • older patients spending the night in the emergency department waiting for admission to a hospital ward are increased risk of morbidity & mortality[41]

Complications

Management

hypertension in hospitalized patients

communication with outpatient physician(s)

Notes

More general terms

Additional terms

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
    Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
    Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
    Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
  2. ↑ 2.0 2.1 Needleman J et al. Nurse staffing and inpatient hospital mortality. N Engl J Med 2011 Mar 17; 364:1037 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21410372
  3. ↑ Bradley EH et al. Hospital strategies for reducing risk-standardized mortality rates in acute myocardial infarction. Ann Intern Med 2012 May 1; 156:618. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22547471
  4. ↑ 4.0 4.1 Hesselink G et al Improving patient handovers from hospital to primary care: A systematic review. Ann Intern Med 2012 Sep 18; 157:417. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22986379
    Prvu Bettger J et al. Transitional care after hospitalization for acute stroke or myocardial infarction. Ann Intern Med 2012 Sep 18; 157:407. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22986378
    Bray-Hall ST. Transitional care: Focusing on patient-centered outcomes and simplicity. Ann Intern Med 2012 Sep 18; 157:448. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22986380
  5. ↑ 5.0 5.1 Goldberg SE et al. Care in specialist medical and mental health unit compared with standard care for older people with cognitive impairment admitted to general hospital: Randomised controlled trial (NIHR TEAM trial). BMJ 2013 Jul 2; 347:f4132 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23819964 <Internet> http://www.bmj.com/content/347/bmj.f4132?ijkey=80c8cd420c4fa9629f6ab82ffdef06043f7c6a76&keytype2=tf_ipsecsha
  6. ↑ 6.0 6.1 Arora VM, Fish M, Basu A et al Relationship between quality of care of hospitalized vulnerable elders and postdischarge mortality. J Am Geriatr Soc. 2010 Sep;58(9):1642-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20863323
  7. ↑ Dykes PC et al, Fall Prevention in Acute Care Hospitals JAMA. 2010;304(17):1912-1918 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21045097 <Internet> http://jama.ama-assn.org/cgi/content/abstract/304/17/1912
  8. ↑ 8.0 8.1 Feldblum I, German L, Castel H, Harman-Boehm I, Shahar DR. Individualized nutritional intervention during and after hospitalization: the nutrition intervention study clinical trial. J Am Geriatr Soc. 2011 Jan;59(1):10-7 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21087222
  9. ↑ Mehta KM, Pierluissi E, Boscardin WJ et al A clinical index to stratify hospitalized older adults according to risk for new-onset disability. J Am Geriatr Soc. 2011 Jul;59(7):1206-16. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21649616
  10. ↑ 10.0 10.1 Zisberg A, Shadmi E, Sinoff G et al Low mobility during hospitalization and functional decline in older adults. J Am Geriatr Soc. 2011 Feb;59(2):266-73. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21314647
  11. ↑ 11.0 11.1 11.2 11.3 Barry LC, Murphy TE, Gill TM. Depression and functional recovery after a disabling hospitalization in older persons. J Am Geriatr Soc. 2011 Jul;59(7):1320-5. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21668916
  12. ↑ 12.0 12.1 12.2 12.3 Pierluissi E, Mehta KM, Kirby KA, et al. Depressive symptoms after hospitalization in older adults: function and mortality outcomes. J Am Geriatr Soc. 2012;60:2254-2262 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23176725
  13. ↑ 13.0 13.1 Wilson RS et al Cognitive decline after hospitalization in a community population of older persons Neurology March 21, 2012 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22442434 <Internet> http://www.neurology.org/content/early/2012/03/21/WNL.0b013e31824d5894.abstract
  14. ↑ 14.0 14.1 Brown CH IV et al. Association of hospitalization with long-term cognitive and brain MRI changes in the ARIC cohort. Neurology 2015 Mar 11 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25762715 <Internet> http://www.neurology.org/content/early/2015/03/11/WNL.0000000000001439
  15. ↑ 15.0 15.1 Attenello FJ et al. Incidence of "never events" among weekend admissions versus weekday admissions to US hospitals: National analysis. BMJ 2015 Apr 15; 350:h1460. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25876878
  16. ↑ 16.0 16.1 Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
  17. ↑ Churpek MM, Yuen TC, Edelson DP. Risk stratification of hospitalized patients on the wards. Chest. 2013 Jun;143(6):1758-65. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23732586 Free PMC Article
  18. ↑ 18.0 18.1 Simon M, Maben J, Murrells T, Griffiths P Is single room hospital accommodation associated with differences in healthcare-associated infection, falls, pressure ulcers or medication errors? A natural experiment with non-equivalent controls. J Health Serv Res Policy. 2016 Jan 24 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26811373
  19. ↑ 19.0 19.1 Milne AC, Potter J, Vivanti A, Avenell A. Protein and energy supplementation in elderly people at risk from malnutrition. Cochrane Database Syst Rev. 2009 Apr 15;(2):CD003288. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19370584
  20. ↑ 20.0 20.1 Lou N Older Hospital Patients Get Better Care from Female Docs. MedPage Today. December 19, 2016 http://www.medpagetoday.com/HospitalBasedMedicine/GeneralHospitalPractice/62156
    Tsugawa Y, Jena AB, Figueroa JF et al Comparison of Hospital Mortality and Readmission Rates for Medicare Patients Treated by Male vs Female Physicians. JAMA Intern Med. 2017;177(2):206-213 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27992617 <Internet> http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2593255
    Parks AL, Redberg RF Outcomes: Equal Rights for Better Work? JAMA Intern Med. Published online December 19, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27992623 <Internet> http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2593252
  21. ↑ 21.0 21.1 Volchenboum SL et al. Association between in-hospital critical illness events and outcomes in patients on the same ward. JAMA 2016 Dec 27; 316:2674 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28027358
  22. ↑ 22.0 22.1 Walker AS, Mason A, Quan TP et al. Mortality risks associated with emergency admissions during weekends and public holidays: An analysis of electronic health records. Lancet 2017 May 9; <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28499548 Free Article <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30782-1/fulltext
  23. ↑ 23.0 23.1 Kane RL, Huckfeldt P, Tappen R et al Effects of an Intervention to Reduce Hospitalizations From Nursing Homes: A Randomized Implementation Trial of the INTERACT Program. JAMA Intern Med. 2017 Jul 3. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28672291
  24. ↑ 24.0 24.1 Pauls LA, Johnson-Paben R, McGready J et al. The weekend effect in hospitalized patients: A meta-analysis. J Hosp Med 2017 Sep; 12:760. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28914284
    Quinn KL, Bell CM. Does the week-end justify the means? J Hosp Med 2017 Sep; 12:779 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28914289
  25. ↑ 25.0 25.1 25.2 Jaiswal SJ, Garcia S, Owens RL. Sound and light levels are similarly disruptive in ICU and non-ICU wards. J Hosp Med 2017 Oct; 12:798. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28991944 <Internet> http://www.journalofhospitalmedicine.com/jhospmed/article/147918/hospital-medicine/sound-and-light-levels-are-similarly-disruptive-icu-and
    Kamdar BB, Martin JL, Needham DM Noise and light pollution in the hospital: A call for action. J Hosp Med 2017 Oct; 12:861. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28991956 <Internet> http://www.journalofhospitalmedicine.com/jhospmed/article/147929/hospital-medicine/noise-and-light-pollution-hospital-call-action
  26. ↑ 26.0 26.1 Bai AD, Srivastava S, Tomlinson GA et al. Mortality of hospitalised internal medicine patients bedspaced to non-internal medicine inpatient units: Retrospective cohort study. BMJ Qual Saf 2018 Jan; 27:11 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29101293 <Internet> http://qualitysafety.bmj.com/content/27/1/11
  27. ↑ 27.0 27.1 Hendin A, Eagles D, Myers V, Stiell IG. Characteristics and outcomes of older emergency department patients assigned a low acuity triage score. CJEM. 2018 Mar 5:1-8 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29502553 https://www.cambridge.org/core/journals/canadian-journal-of-emergency-medicine/article/characteristics-and-outcomes-of-older-emergency-department-patients-assigned-a-low-acuity-triage-score/0237D91AAFABFB10685A51D082E086D7
  28. ↑ Lawrence D, Shah AK, Lee EK et al. Primary care provider preferences for communication with inpatient teams: One size does not fit all. J Hosp Med 2018 Mar; 13:177. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29154380 https://www.journalofhospitalmedicine.com/jhospmed/article/150917/hospital-medicine/primary-care-provider-preferences-communication-inpatient
  29. ↑ 29.0 29.1 Bevan R, Grantham-Hill S, Bowen R et al. Sleep quality and noise: Comparisons between hospital and home settings. Arch Dis Child 2018 Jul 17; PMID: https://www.ncbi.nlm.nih.gov/pubmed/30018067
  30. ↑ 30.0 30.1 Wesselius HM, van den Ende ES, Alsma J et al. Quality and quantity of sleep and factors associated with sleep disturbance in hospitalized patients. JAMA Intern Med 2018 Jul 16; PMID: https://www.ncbi.nlm.nih.gov/pubmed/30014139 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2687528
    Growdon ME, Inouye SK. Minimizing sleep disruption for hospitalized patients: A wake-up call. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30014149 JAMA Intern Med 2018 Jul 16; https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2687522
  31. ↑ 31.0 31.1 Martinez-Velilla N, Casas-Herrero A, Zambom-Ferraresi F et al Effect of Exercise Intervention on Functional Decline in Very Elderly Patients During Acute HospitalizationA Randomized Clinical Trial. JAMA Intern Med. Published online November 12, 2018. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30419096 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2714300
    Hall WJ. A Novel Exercise Intervention and Functional Status in Very Elderly Patients During Acute Hospitalization. JAMA Intern Med. Published online November 12, 2018. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30419130 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2714298
  32. ↑ 32.0 32.1 Arora VM, Machado N, Anderson SL et al. Effectiveness of SIESTA on objective and subjective metrics of nighttime hospital sleep disruptors. J Hosp Med 2019 Jan; 14:38 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30667409
  33. ↑ 33.0 33.1 Jacobs ZG, Najafi N, Fang MC et al. Reducing unnecessary treatment of asymptomatic elevated blood pressure with intravenous medications on the general internal medicine wards: A quality improvement initiative. J Hosp Med 2019 Mar; 14:144. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30811319 https://www.journalofhospitalmedicine.com/jhospmed/article/195045/hospital-medicine/reducing-unnecessary-treatment-asymptomatic-elevated-blood
    Pasik SD, Chiu S, Yang J et al. Assess before Rx: Reducing the overtreatment of asymptomatic blood pressure elevation in the inpatient setting. J Hosp Med 2019 Mar; 14:151. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30811320 https://www.journalofhospitalmedicine.com/jhospmed/article/195046/hospital-medicine/assess-rx-reducing-overtreatment-asymptomatic-blood
    Anstey J, Lucas BP. Treatment of inpatient asymptomatic hypertension: Not a call to act but to think. J Hosp Med 2019 Mar; 14:190 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30811330 https://www.journalofhospitalmedicine.com/jhospmed/article/195057/hospital-medicine/treatment-inpatient-asymptomatic-hypertension-not-call-act
  34. ↑ 34.0 34.1 Schuetz P, Fehr R, Baechli V et al. Individualised nutritional support in medical inpatients at nutritional risk: A randomised clinical trial. Lancet 2019 Jun 8; 393:2312 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31030981
  35. ↑ 35.0 35.1 Kyi M, Colman PG, Wraight PR et al. Early intervention for diabetes in medical and surgical inpatients decreases hyperglycemia and hospital-acquired infections: A cluster randomized trial. Diabetes Care 2019 May; 42:832. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30923164 https://care.diabetesjournals.org/content/42/5/832
  36. ↑ 36.0 36.1 Krause BM, Sabia S, Manning HJ, Singh-Manoux A, Sanders RD. Association between major surgical admissions and the cognitive trajectory: 19 year follow-up of Whitehall II cohort study. BMJ 2019 Aug 7; 366:l4466 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31391161 Free PMC Article https://www.bmj.com/content/366/bmj.l4466
  37. ↑ 37.0 37.1 Young DL, Colantuoni E, Friedman LA et al, Prediction of disposition within 48-hours of hospital admission using patient mobility scores. J Hosp Med 2019 Dec 23; 14:E1-E4. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31869298 https://www.journalofhospitalmedicine.com/jhospmed/article/212336/hospital-medicine/prediction-disposition-within-48-hours-hospital-admission
  38. ↑ 38.0 38.1 Hastings SN et al. Effects of implementation of a supervised walking program in Veterans Affairs hospitals: A stepped-wedge, cluster randomized trial. Ann Intern Med 2023 Jun; 176:743. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37276590 https://www.acpjournals.org/doi/10.7326/M22-3679
  39. ↑ 39.0 39.1 Anderson TS et al. Clinical outcomes of intensive inpatient blood pressure management in hospitalized older adults. JAMA Intern Med 2023 Jul; 183:715. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37252732 PMCID: PMC10230372 (available on 2024-05-30) https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2805021
  40. ↑ 40.0 40.1 Rastogi R, Sheehan MM, Hu B, Shaker V, Kojima L, Rothberg MB. Treatment and outcomes of inpatient hypertension among adults with noncardiac admissions. JAMA Intern Med 2020 Dec 28; PMID: https://www.ncbi.nlm.nih.gov/pubmed/33369614 https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2774562
  41. ↑ 41.0 41.1 Roussel M, Teissandier D, Yordanov Y et al Overnight Stay in the Emergency Department and Mortality in Older Patients. JAMA Intern Med. Published online November 6, 2023. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37930696 PMCID: PMC10628833 Free PMC article. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2811179
  42. ↑ 42.0 42.1 Bates DW, Levine DM, Salmasian H et al The Safety of Inpatient Health Care. N Engl J Med. 2023 Jan 12;388(2):142-153. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36630622 https://www.nejm.org/doi/10.1056/NEJMsa2206117
  43. ↑ 43.0 43.1 43.2 Wilson LM, Herzig SJ, Steinman MA et al. Management of inpatient elevated blood pressures: A systematic review of clinical practice guidelines. Ann Intern Med 2024 Apr 2 PMID: https://www.ncbi.nlm.nih.gov/pubmed/38560900 Review. https://www.acpjournals.org/doi/10.7326/M23-3251
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