Alternatives to Hospitalization for Frail Elders

According to Dr. Muriel Gillick, a physician who specializes in the care of elderly patients (geriatrics) and those with advanced illness (palliative care),trying to prevent geriatric medical problems that often lead to hospitalization – such as falls or episodes of heart failure-- is extremely difficult. But the hazards of hospitalization for frail patients can include adverse drug reactions, falls, delirium, and incontinence.
 
Dr. Gillick believes that when patients learn the risks of hospitalization and comprehend their frail status, they might decide to forgo hospital treatment if they have a reasonable alternative.  She describes some excellent options, including hospice and home hospital programs. She also touches upon the barriers to implementing hospital alternatives which include a Medicare minimum requirement for hospital stays; the convenience to clinicians of hospitalizing rather than arranging care with other facilities or home care givers; and patient wishes to avoid burdening their families with their care.
 
Dr. Gillick concludes that frail elders cannot be expected to avoid hospitals entirely, and that hospitalization might be the most appropriate course of treatment for some patients. But we need to minimize the need for hospitalization both with adequate transitional care, effective management of geriatric medical issues, and an integrated, coordinated system of care and also with viable alternatives to hospital treatment.
 
To view the Annals of Internal Medicine article click here.