Inpatient Geriatric Consultations — Not What They Used to Be
Inpatient Geriatric Consultations — Not What They Used to Be
By Quratulain Syed, MD
Geriatric Times - 2012 The Cleveland Clinic Foundation
Those of us who read Dr. Atul Gawande’s article titled “Big Med,” published in the Aug. 13, 2012, edition of The New
Yorker, learned about the shocking experience David Luz had when his 78-year-old mother was admitted
to a hospital after an episode of syncope and a fall.
As Luz recounts, his mother stayed in the hospital overnight, underwent an extensive workup and was discharged home the next day without any clear explanation or any proper discharge paperwork or plan. Luz says of the experience: “We didn’t get to go until 6 p.m., with a tired, disabled lady and a long drive home.” In addition, Luz and his mother both struggled to navigate the post-discharge follow-up. These sentiments are shared by most families who have witnessed a loved one being admitted to a hospital and undergoing a significant yet unexplained physical and cognitive decline in a matter of a few days. Primary care physicians also go through a frustrating ordeal when an older adult patient is admitted to a hospital. They find frustrating the lack of communication from the staff on the inpatient side, especially when the patient is discharged home or to a rehabilitation facility with unclear documentation about the hospital course and post-discharge plan. Inpatient teams experience an equally difficult situation when trying to communicate with an agitated or lethargic, delirious older adult with multiple medical problems, scant patient history on admission, unavailable records from primary care providers and, frequently, few involved family members. Medical professionals also struggle with avoiding frequent readmissions for chronic diseases, an especially complex and frustrating situation in a country such as ours that is facing a significant shortage of primary care services. These personal experiences are supported by national and global data about higher readmission rates and the hazards of hospitalizations for older adults, such as polypharmacy, instrumentation, malnutrition and long- term cognitive and functional decline.
