A Hospital Is No Place for Sick People

By: Dr. Mark LachsWhat Patients and Families Can Do to Better Understand the Hospital EnvironmentIn the course of getting older most of us will be admitted to the hospital at least once, and maybe more than once. Given this inevitability, my message to you is that there are specific steps that you can take to facilitate a positive outcome. For any hospital experience, first and foremost you need to understand the hospital environment. By simply understanding how things work, you can improve the likelihood of achieving your goal – staying safe, getting better, and going home.As we get older, the risk of getting sick from hospitalization itself - regardless of the symptoms that put you in the hospital in the first place - increases. Why is this? The hospital is a place where your normal routine - mobility, nutrition, sleep, elimination, access to creature comforts - gets interrupted. These interruptions can cause or exacerbate illness in and of themselves. This, coupled with advancing age, compounds the risks of hospitalization. Think about it – with age comes more medications, more medical problems, more caregivers, less physiologic reserve, and a more precarious support system at home.Common Problems We May Face When Hospitalized?Think about some of the things we do to folks in our grand hospital institutions. First, we put you to bed. Bedrest, however, wastes your muscles, which can promote the development of pressure sores. Bedrest also has the effect of redistributing body fluids which can cause dizziness and balance problems. Then, we keep waking you up! Sleep disruption plays a significant role on the development of what geriatricians call “acute confusional state.” Sometimes a bladder catheter is used to collect urine. Once it’s removed, it can cause the bladder muscles to become deconditioned. And if that’s not enough, in the hospital all the comforts of home are vanquished, including the absence of a good home cooked meal.3 Steps You Can Take to Navigate the Hospitalization Process & Mitigate Complications

1. Answer the question ‘Who the Hell Are all These People’?

• Who is your attending? Who is responsible for coordinating and directing your care?
• Is your attending your private physician or is it a hospitalist? A hospitalist is someone to whom your private physician hands you off to while you are hospitalized to manage your care.
• Are there consultants involved in your care? These are usually specialists who treat patients with your specific condition.
• Who is the nurse primarily assigned to cover you for each shift?
• Then there are the host of other staff: residents, students, fellows, nurses, therapists, technicians, patient care assistants.
• If needed, you may also have others assigned to your care, such as physical therapists, social workers, and speech therapists.

2. Figure Out If you are at High Risk for Hospitalitis (Confusion and Other Hospital Related Problems)

• Your medical history, as well as treatments prescribed during your hospitalization can both contribute to determining whether you are at high risk. Previous history of dementia, for example, is a high-risk factor.
• There is a striking dose-response curve that predicts the likelihood of hospitalitis based on the factors you bring with you or develop while you’re there.
• Identifying your risk puts staff on alert to be extra vigilant with your care. It also allows staff to tailor interventions to mitigate potential problems.

3. If You Are at Risk, Try these Simple Interventions

• Bring your complete medication list, as well as your doctors’ names and contact information.
• Encourage regular visits: Rather than sit and watch television, engage in substantive, engaging mental activities with the patient, like playing cards or a board game or discussing current events.
• Keep the patient oriented: Simply reminding patients what day of the week it is, what time it is, who is taking care of them and what’s in store for the day with regard to tests and physician visits can be helpful.
• Mobilize as soon as possible: Be aggressive about asking your doctor when it is safe to get out of bed and into a chair and/or when you can walk.
• Use nondrug approaches to restoring sleep: Ask for warm milk or herbal tea. Bring your relative an iPod with soothing music.
• Remember glasses and hearing aids: If you wear them, bring them, or send someone to get them if you’ve left them at home.
• Plan visits around meals: Assistance and companionship during meals is critical, but never feed your relative or friend without the okay of the staff.
• Bring a few familiar objects from home, such as family photos or a favorite blanket.

It’s ironic that the very places that have been constructed to improve our health – hospitals – can become pernicious places as we age. Scans, tests, blood work, and other technology can sometimes distract from the actual work of healing, and actually seeing what is happening to the patient write in front of us. The good news is that all the above techniques and steps are rooted in common sense and compassion, and potentially deliverable by family members, friends or any volunteer who cares about older people.