More than half of general hospital admissions involve adults age 65 and older — many of whom are hospitalized repeatedly for complications from chronic conditions, such as heart disease, high blood pressure and diabetes.

Problem: Even a short hospitalization of two or three days often precipitates a serious health decline — primarily due to the high rate of hospital-acquired infections and medication errors.

Solution: As many as one-third of repeat hospitalizations among older adults are preventable.

To learn more, Bottom Line/Health recently spoke with Mary D. Naylor, PhD, RN, a leading researcher at the University of Pennsylvania who has studied the problem of frequent hospitalizations among older adults for nearly two decades. Naylor’s advice…

STEP 1: BE AWARE OF
YOUR WARNING SIGNS

Patients who know what symptoms to watch for are far more likely to seek prompt medical attention at a doctor’s office. This often can remedy a potential problem without emergency room or hospital care.

Example: Fluid retention (in the feet, legs or abdomen) is one of the first signs of heart failure (inadequate pumping action of the heart) that is poorly controlled. This usually can be reversed by changing a drug or adjusting a prescribed dosage.

Self-defense: Ask your health-care provider to list early symptoms of any chronic conditions you may have and the best ways to watch for these changes. Write down the symptoms and keep them in a conspicuous location, such as on your refrigerator.

STEP 2: DON’T SETTLE FOR A
STANDARD DISCHARGE

When a patient is discharged from a hospital, he/she is given basic instructions for ongoing care. But this process is rarely adequate.

Self-defense: Don’t leave the hospital until you and/or a family member completely understand your next steps. Before discharge, find out which medications you received that day, when the next dose is due, and any changes that require filling a new prescription or increasing or decreasing the dosage taken before you were admitted.

You also need to know how soon you should see your doctor after discharge. Insist on getting the name and phone number of someone you can contact — including after-hours — if you have questions. Ideally, this will be one of the doctors or nurses who is most familiar with your medical history.

STEP 3: DO MEDICATION CHECKS

Medication errors (such as being given the wrong medication or no dosage instructions) are a main cause of repeat hospital admissions. Potentially dangerous drugs, such as warfarin (Coumadin) or other types of blood-thinning medication, are among the drugs most commonly involved in repeat hospitalizations.

When researchers at the University of Pennsylvania tracked patients after their discharge from the hospital, they found a 70% error rate in medication use. For example, some patients were given inaccurate information about medication types or doses… or drugs that were discontinued when patients entered the hospital weren’t always restarted once they left.

Self-defense: Keep an up-to-date list of your medications (including over-the-counter drugs) and supplements where family members can find it if you go to the hospital unexpectedly. In the hospital, post a list of your medications beside your bed in the hospital. Every time you see a new doctor, ask him to review the list.

Helpful: Don’t throw away your older lists. Compare older medication lists with the newest one. If there’s been a change in a drug or dose, ask your doctor about it to ensure that it’s not a mistake.

STEP 4: PREVENT FALLS

Falls account for about 1.8 million emergency room visits and 16,000 deaths annually in the US. People who fall, especially older adults, often experience a cascade of complications — for example, a bone fracture can lead to extended periods of immobility that increases risk for pneumonia, which often requires hospitalization.

Self-defense: If you’re age 70 or older, get a comprehensive assessment from a geriatrician once a year.* He will look at fall risk factors, such as muscle strength, balance and vision changes.

Helpful: Improve your muscle strength with regular exercise such as walking or swimming. Specific exercises that improve balance include one-legged stands, in which you stand on each leg (near a counter so you can catch yourself if you lose your balance) for 30 seconds several times a day.

STEP 5: ASK FOR A
MENTAL ASSESSMENT

Most doctors don’t routinely check for mental changes.

Recent study: When University of Pennsylvania research assistants went to a number of hospitals to conduct rigorous cognitive assessments, they found that more than one-third of older patients admitted for complications from chronic diseases had some degree of cognitive impairment (primarily memory loss). Of those patients, 65% had never been identified as having memory problems, which increases a person’s risk for making the kinds of mistakes (such as forgetting to take medication) that can lead to hospitalization.

Self-defense: Ask your primary care provider whether you should see a geriatrician or neurologist to have your cognitive functioning evaluated. Testing, which takes about 10 to 20 minutes, typically involves measuring your ability to complete simple memory and/or motor tasks.

STEP 6: EAT WELL

Malnutrition and dehydration are common in older adults and can result in gradual declines in mental and physical functioning.

Self-defense: Get a nutritional assessment from your health-care team. Also, keep a diary in which you write down everything you eat and drink, as well as your eating patterns (for example, time of day) and settings, for one to two weeks.

People who do nothing more than eat nutritiously and drink enough fluids are far less likely to require hospitalization — or to suffer complications from underlying chronic diseases.

*To find a geriatrician in your area, contact the American Geriatrics Society’s Foundation for Health in Aging, 800-563-4916, www.healthinaging.org.