When It’s OK to Treat Older Adults Like Children

DharmarajanHospitalization is a difficult experience for many older adults. Sleep is often disturbed due to frequent nighttime interruptions for vital signs checks, medication administrations, and diagnostic procedures. Mobility is compromised due to “one-point restraints” including urinary catheters and intravenous lines. Forced fasting is frequent. And anxiety is common due to unfamiliar surroundings, multiple changes in provider teams, shifting care plans, suboptimal communication with providers, and sick roommates.

By inducing stress and anxiety, these common experiences of hospitalization may contribute to the high levels of vulnerability experienced by older adults after hospital discharge. While data in humans are lacking, previous work with laboratory animals has shown that prolonged exposure in controlled settings to sleep disruptions, immobilization, food restriction, and unfamiliar cagemates results in endocrine dysregulation, anhedonia, impaired immune response, and even vascular thromboses. These effects occur even among young healthy animals. It is highly likely that hospitalized older adults with acute illness, multimorbidity, geriatric conditions, and reduced physiologic reserves are even more susceptible to the exogenous stressors that are common during hospital stays.

So how can we do better? One way would be to apply strategies we already use when caring for hospitalized children. I recently had the chance to discuss this perspective for the Wall Street Journal.

Here are some highlights:

  1. Children’s hospitals minimize exposure to hospital stressors. Providers in these institutions avoid waking kids up at night and try to eliminate unnecessary procedures like routine blood draws. The environment is designed to actively lift children’s spirits through bright and cheerful surroundings, dedicated play areas, and music and art therapy.
  1. Children’s hospitals almost universally provide children with access to child life specialists, who have been trained to engage with children and their families to permit age-appropriate expression and minimize anxiety. These individuals have completed formal training to become child life specialists. There is no common parallel in geriatric medicine.
  1. Parents are routinely made active members of the care team during and after hospitalization. As a result, they can prepare children for medical interventions, support them throughout their illness, and improve compliance with care plans. Too often, we ignore opportunities to similarly engage the family members and caregivers of hospitalized older adults.

In the end, we have multiple opportunities to improve the care of hospitalized older adults. Strategies commonly used with children in typical clinical practice provide one useful and very doable starting point.

By: Kumar Dharmarajan, MD