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A Trigger for Hospital Readmissions ID'd by Geriatric Experts

Cheryl Clark, for HealthLeaders Media, October 15, 2012

A phenomenon in acute care—hospitalization-associated disability—raises an important question.  Might providers focus so intently on resolving patients' acute care issues that they ignore and thereby irrevocably damage patients' functional abilities in the process?

After discharge, patients' brains sometimes aren't working as sharply as they were prior to their admission or patients can't walk as far or manage steps like they did before, geriatric experts have long observed.

But why? Edgar Pierluissi, MD, medical director of the San Francisco General Hospital Acute Care for Elders unit, or ACE, says that this insidious process is a fact of life for about one-third of patients 70 and older after hospitalization. Often, it means they can't return home, and must spend the rest of their lives in skilled nursing care.

"You can't provide medical care in a hospital and not see this every day, or else you're not paying attention; you treat people (successfully) and yet they are worse off," Pierluissi says. "If you're really interested in reducing readmissions and hospital complications, you have to face these facts."

Undergoing the process of care can mean being bedbound in a noisy room that's depersonalizing and not conducive to deep sleep for durations of weeks or longer. Combined with eating restrictions and isolation, the environment can be a risk for falls and limit ambulation.

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