November 15, 2016

On Call Geriatricians Reduce Hospital Stay Risks for Elderly

Inpatient Geriatric Consultation Service improves outcomes

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National and global data demonstrate the dangers of hospitalization for geriatric patients.

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“Most hospitalized individuals are age 65 and older, and hospitalization for these patients is associated with a number of hazards,” notes Ronan Factora, MD, Interim Director of the Center for Geriatric Medicine and Codirector of the Aging Brain Clinic. These problems include development of delirium, long-term cognitive and functional decline, malnutrition/weight loss, instrumentation, problems with transitions of care in and out of the hospital (including omitted medications and unmanaged chronic medical problems), polypharmacy and prescription of inappropriate medications.

Mitigating hazards

The Inpatient Geriatrics Consultation Service at Cleveland Clinic main campus helps mitigate these dangers by connecting the dots between primary, acute and post-acute care. Geriatricians – keenly aware of potential complications – help identify problems, avoid issues and improve outcomes for older hospitalized patients. The service works closely with admitting physicians and collaborates with physicians and practitioners in hospital medicine, neurology, cardiology, intensive care, orthopedic surgery, cardiothoracic surgery and more.

Consultative services are provided on issues ranging from polypharmacy to gait impairment and falls, cognitive impairment and delirium, elder abuse and neglect, goals of care in patients with multiple comorbidities and other geriatric syndromes.

A staff geriatrician along with an internal medicine resident and geriatrics fellow comprises the consult team.

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Systematic approach

“Our approach is systematic,” says Luke Kim, MD, staff in the Center for Geriatric Medicine. “We review overall acute issues and then emphasize areas unique to our patients, such as working with other providers on to manage cognitively challenged older adults in the setting of acute illness.” The consult service also works closely with family members, case managers and social workers to ensure a comfortable hospital stay and safe discharge.

“When one of my patients is admitted to the hospital, I receive an alert through the EMR,” explains Amanda Lathia, MD, staff in the Center for Geriatric Medicine. “While I may not consult on this specific patient, I can follow their care and alert their inpatient providers of any relevant chronic problems and help manage cognitive issues and other geriatric syndromes.”

Help with delirium

“We’re often asked to help assess and manage patients who have delirium, to identify the cause, help alleviate disruptive symptoms and shepherd the patient through to their transition out of the hospital,” Dr. Factora notes.

Geriatricians help ensure the acute problems are addressed, and make sure the patients’ chronic medical problems and medications are given proper attention posthospitalization, Dr. Factora continues. “Postdischarge plans also address how function can be restored, with the ultimate goal of having these persons return to their previous living arrangements, as close to their prior level of function as possible.” Many patients see the geriatric medicine team again, either in an outpatient clinic or a home care setting.

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The Inpatient Geriatrics Consultation Service helps ensure a smooth transition for elderly patients and that they receive the resources needed to maintain their residence in the community. Most importantly, reduced emergency department visits and readmission rates show that the program is keeping geriatric patients healthier, longer.

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