10 Commandments of Care for the Hospitalized Elderly

 

1. Bed rest is for dead people (and a few others). Get people moving!;   1 day in bed = 5% total strength loss, takes 3 days of intense rehab to erase; Hospital Associated Functional Decline → inability to care for self developing during acute illness, affects 30% of older inpatients!

• The fewer drugs, the better. Review & tailor meds daily.
  Hospitalization is an opportunity to reduce inappropriate outpatient meds; don’t be shy about talking statins, BP meds!
• Curate tethers (legami) : remove IVs, catheters ASAP (aspiration catheter kit). Make a case for adding tethers inthe first place
• Delirium is a medical emergency. Assess cognitive statusdaily ;… prevention is KEY

5. Treat with antipsychotics only when necessary; start with low oral doses for dangerous or refractory behaviors.
6. Treat restraints as a last resort
7. Watch for and address depression
8. Pay attention to food & fluids consumed. Ask early if intakedeclines Remember taste and thirst thresholds are higher in older adults!
9. Discharge planning starts on admission!
10. Be proactive discussing goals of hospitalization