Editorial: Improving Acute Care for Elders at Risk for Poor Hospital Outcomes

For patients older than age 65, traditional hospital care frequently results in adverse outcomes that increase their risk of mortality, functional dependency, and institutionalization. For example, more than one third of patients discharged from an acute hospitalization are discharged with worse functional status than their baseline. Moreover, half of these patients acquire their new impairments during hospitalization, despite the stabilization of their acute illness. There are several alternative models to traditional hospital care which have been shown to address these problems and improve outcomes for older patients. One such model is VA's Geriatric Evaluation and Management (GEM) program, which was launched in 1976 to provide interdisciplinary, multi-dimensional evaluations for elderly Veterans in need of geriatric treatment, rehabilitation, health promotion, and social service interventions. However, alternative models are not widely disseminated; for example, GEM units are in less than one third of VAMCs and do not exist outside VA. Lack of awareness among patients and providers about alternatives to traditional hospital care is a barrier to the wider dissemination of these programs, yet, when patients and caregivers are made aware of these alternatives, they frequently prefer them.

This Editorial challenges healthcare providers to think outside the traditional hospital box. For example, the authors suggest that perhaps the time has come for a public health campaign to educate consumers and healthcare providers about acute care alternatives for older patients. They also suggest broadening the implementation and availability of programs such as GEM and Hospital at Home (non-VA program providing hospital-level care of elders in their own homes) for those patients who would benefit from acute care outside a hospital setting.

Kao H and Walter L. Improving hospital care of elders: Thinking outside the (hospital) box. ‘Editorial,’ Archives of Internal Medicine September 28, 2009;169(17):1576-77.

Dr. Walter is part of HSR&D's Program to Improve Care for Veterans with Complex Comorbid Conditions in San Francisco.