Older adults have a much greater chance of being admitted to the hospital than any other age group in the United States. People 65 years old and older make up just 13% of the US population, but account for 36% of hospital admissions for acute care and nearly half of hospital spending for adult care. This trend is expected to increase rapidly as the US population continues to age.

• Reasons for Hospitalization
• Protecting Yourself in the Hospital
• Before you go to the hospital
• Planning for your trip to the hospital
• Things to know about being in the hospital
• After admission
• Your rights in the hospital
• Aggressive treatment
• Surgery
• Choosing a surgeon
• Assessing surgical risk
• Risk due to age
• Heart assessment
• Lung assessment
• Smoking
• Other risk factors
• Complications after surgery
• Heart complications
• Lung complications
• Blood clots
• Diabetes
• Mental disorders
• Pain management
• Leaving the Hospital

There are many reasons why you might need to go to the hospital. Common reasons include the following:

In general, hospitals are staffed by trained professionals who want to do what is best for you. However, as in any large organization, things sometimes fall through the cracks or get overlooked. Therefore, it is important that both you and your loved ones watch out for your interests throughout your hospital stay. After all, mistakes and accidents can happen in the hospital just like anyplace else. The best way to avoid problems is to pay attention to what is going on and to ask plenty of questions.

Before you agree to be admitted into a hospital, there are several important questions you should ask:

It is also important to prepare yourself (if possible) for a trip to the hospital. Some pre-hospital planning can help.

Make a list of questions or concerns to discuss with your doctor before you go to the hospital.

• Ask your doctor how you can reach him or her while you are in the hospital.
• Make a list of your medical conditions, current medications, and drug or food allergies. Bring this list with you to the hospital. Also bring your insurance information and the names and phone numbers of family and friends.
• Label personal items (hearing aids, dentures, eyeglasses) with your name and address.
• Leave jewelry and other valuables at home

• Take a few personal belonging to the hospital, such as photographs of a loved one, to provide comfort and reassurance during your stay. Again, avoid bringing valuable or irreplaceable items that might be lost or stolen.

It is normal to have concerns about going into the hospital. After all, people in the hospital are ill and face undergoing uncomfortable medical or surgical procedures. Other things about being in the hospital can also be confusing or frustrating. Knowing about these ahead of time can help ease your mind and prevent frustration.

When you’re admitted, you’ll need to consider what type of room to get, how much it will cost, whether a telephone or television can be provided in the room, and whether special dietary concerns can be handled. Generally, you will have to sign a form agreeing to the type of care that is being provided: This is not a consent form for specific kinds of treatment. You will be asked to sign forms for specific procedures when they are performed. You will also need to sign forms that specify your method of payment and that give the hospital permission to share information concerning your circumstances with the organizations involved in paying for your care (eg, insurance companies).

While in the hospital, you have a number of rights:

Treatment of older patients often focuses on return to function and quality of life, rather than simply keeping people alive. In fact, compared with younger adults, fewer older adults want aggressive treatments aimed solely at prolonging life. For these reasons, older patients tend to receive less invasive and less costly hospital care than younger patients with similar conditions. Unless told otherwise, hospital staff may simply assume that an older patient does not desire aggressive treatment or treatment aimed solely at prolonging life. Therefore, it is important that you discuss your feelings on this topic with your doctor, other health care providers, and your family before and during your hospital stay. Your wishes for aggressive or heroic therapy should also be a part of any living will (see also Palliative Care and End of Life Issues).

Surgery is a common reason for going into the hospital, with about one in five people over the age of 65 having surgery in any given year. About 20% of all open-heart procedures are performed on people over the age of 70. Keep in mind that approximately one-quarter to one-third of all surgical procedures performed in the United States may not be necessary. Getting a second opinion before deciding to have any kind of elective surgery is almost always a good idea.

Choosing a surgeon is within your control. Sometimes your personal physician helps by recommending a surgeon, but you are ultimately in charge of this decision. Having family meet with the surgeon and discussing your choice with loved ones can also help.

You may also want to ask the surgeon who will be managing the anesthesia. What matters most concerning an anesthesiologist is that the surgeon feels comfortable with the anesthesiologist’s work, reputation, and expertise.

Some factors can increase your risk of complications associated, including death, that are associated with surgery. Three issues are most often considered in the evaluation for surgery:

The risk associated with surgery generally increases as we age. However, surgical risk for older adults in the United States has steadily declined over the past 40 years because of medical advances. In fact, elective surgery on people over 80 years old was safer in the 1990s than the same procedures performed on younger people in the 1960s. Multiple medical problems and the urgency of the procedure are far more important factors than age in predicting possible complications. People over the age of 80 can generally undergo even major surgery without undue risk of death.

Problems with the heart and lungs are the most serious postoperative complications. Narrowed arteries that reduce blood flow to the heart, previous heart attacks, congestive heart failure, and disturbances of heart rhythms are serious problems that increase surgical risk. Other conditions, such as stable heart pain (ie, angina pectoris), compensated congestive heart failure, and well-controlled high blood pressure do not contribute unduly to the risk of heart complications.

Your physician and the hospital staff will assess your risk of heart complications before surgery by specifically considering the following six factors:

• Surgeries involving the chest, upper abdomen, or other high-risk areas of the body
• History of narrowed arteries or previous heart attacks
• History of congestive heart failure
• History of diabetes that requires insulin
• Chronic kidney disease
• History of stroke.

Older adults who do not have any of these factors are at low risk of heart complications after surgery and only routine, noninvasive tests will be performed beforehand. These usually include an electrocardiogram. People who have one or two risk factors are at a moderately increased risk and may need to undergo additional noninvasive testing. For example, you may be asked to take a stress test of your heart. If you cannot complete the stress test or raise your heart rate above 100 beats per minute, you may have an increased risk after surgery, but use of medicines to protect the heart may still allow the surgery to be done People who have three or more risk factors are at high risk of heart complications and may need more invasive tests (eg, passing a tube into the blood vessels of the heart to test for narrow arteries).

As we age, our lungs lose some of their elasticity (ability to expand and contract) and their ability to move air. To reduce the risk of lung complications after surgery, especially pneumonia, you must be able to generate enough airflow to expel mucus that can accumulate in your lungs during surgery. Preoperative testing occasionally includes a test of lung function.

There are proven strategies to prevent lung complications in high-risk patients. First and most importantly, smokers should stop smoking at least 8 weeks before surgery. People coughing up colored phlegm should receive preoperative antibiotics. Other successful treatments include opening the airways (with inhaled medication), shifting body positions to increase drainage of chest fluid, and performing physical therapy of the chest.

Cigarette smoking is a major risk factor for complications after surgery. Smokers are most likely to have the following:

Additional risk factors include the following:

Evaluation and management techniques for older adults undergoing surgery are constantly being improved. This has made surgery much safer and has decreased the risk of complications. However, complications can still occur, especially in older adults who have one or more risk factors.

The most life-threatening complications are those involving the heart. Up to one in 20 older adults undergoing surgery will die from heart complications. Your risk of a heart attack extends through the first two weeks after surgery, and there is no chest pain in over half of these heart attacks. Older patients are routinely monitored for heart problems during this time. Patients found to be at risk of heart problems are often asked to take medicines that protect the heart for a week before and up to two weeks after elective surgery. Some physicians perform an electrocardiogram on the day of surgery and on the first two or three days after surgery. Others recommend continual monitoring of the heart during this time.

Congestive heart failure after surgery is most likely to develop in people who have heart failure before surgery. However, half of the people who develop heart failure after surgery have had no previous evidence of it.

Other risk factors for heart failure after surgery include the following:

• surgeries involving the chest or abdomen
• advanced age
• an abnormal electrocardiogram before surgery

The lungs are a common site of complications after surgery (eg, pneumonia), most commonly after surgery of the chest or upper abdomen. Lung complications also prolong the hospital stay of older patients by an average of 1-2 weeks. Common conditions such as obesity, malnutrition, dementia, skeletal abnormalities, and general muscular weakness may also increase the risk of lung complications after surgery.

Collapse of the small airways in the lungs and increased secretions in the lungs often result in pneumonia after surgery. Factors that can increase the risk of airway collapse include the following:

• smoking
• lying on the back
• incisions near the diaphragm
• obesity
• pain on breathing
• sedation
• excess sticky secretions that cause plugging

To lessen these risks, smokers should quit for at least 8 weeks before surgery. Other lung diseases should also be treated before surgery. And perhaps most importantly, people need to get out of bed and start walking as soon as possible. Standing along with deep breathing and coughing is the best (and only) way to open airways and prevent pneumonia. You may be tired, and standing may not be comfortable, but this is important preventive medicine!

Detectable clots (called thromboses) in the deep veins of the leg develop in about half of all older adults undergoing surgery, unless they receive preventive measures. Bone surgery (especially hip surgery) and surgery in people with cancer increase this risk. Various treatments reduce the risk of complications related to blood clots. Blood thinners such as heparin and warfarin prevent clots from forming in the deep veins in the legs. These medicines are often used along with leg pumps and stretch stockings to minimize the risk of blood clots.

If you have diabetes, you should receive glucose and insulin both before and after surgery. Also, a day or two before surgery your doctor will ask you to discontinue any oral medications used to lower blood sugar, to avoid your blood sugar being low at the time of surgery.

Depression is common in older people and, unfortunately, may decrease their interest in recovery after surgery. Depression should be treated before any elective surgical procedures are performed (see Psychological Conditions).

Dementia is a severe form of memory impairment that is a major risk factor for complications after surgery. In addition, delirium (acute confusion) after surgery is much more common in people who have dementia before surgery.

Confusion is common in older adults recovering from surgery. Up to a fourth of older adults develop a severe form of confusion called delirium. Episodes of delirium can be caused by the following:

• medications
• infection
• low oxygen levels
• heart problems
• changes in body chemistry (eg, low levels of sugar or sodium in the blood)
• severe constipation
• urinary problems
• lack of sleep
• monotony
• being in an unusual place

The first priority in the management of a person with delirium after surgery is to recognize and correct any of these factors. Because you will not be able to recognize delirium in yourself, close observation and assistance by family members, hospital staff, or paid caregivers may help reduce your risk of injury until you recover. In addition, some research suggests that better control of pain may reduce postoperative delirium. Other ways to reduce risk of delirium after surgery, or during hospital stays for other reasons, include the following:

• wearing eyeglasses and hearing aids
• getting out of bed and walking
• ensuring a good night’s sleep (warm milk and back rubs are better than sleeping pills)
• having family and friends at the bedside
• keeping clocks and calendars at the bedside, and reorienting the patient
• drinking plenty of fluids or if intravenous fluids are needed, getting enough but not too much
• keeping up good nutrition, eating favorite foods or even frequent small snacks

Pain is common in hospitalized older adults and is almost universal after surgery. Everyone who undergoes surgery should be monitored frequently for pain. "Rating scales" are often used to try to estimate the amount of pain you are reporting. Some older adults with mental impairment may be unable to report pain and should be observed for behavioral signs of pain (see Palliative Care and End-of-Life Issues).

Hospital staff should try and determine the cause of substantial pain and eliminate it if possible. Acetaminophen is effective for mild pain, does not upset the stomach, and may add to the anti-pain effect of other agents. Narcotics are generally effective for severe pain in most situations, and the risk of addiction in short-term treatment is minimal. Nonsteroidal anti-inflammatory agents (eg, aspirin or ibuprofen) are also effective, but are commonly avoided after surgery because of potential side effects. Treatment approaches that do not involve medication include the following:

• heat
• cold
• massage
• immobilization
• mental techniques (eg, relaxation, imagery, distraction, education, music, pet therapy, and biofeedback

A hospital discharge planner will help you prepare for your discharge. This process can take from a few hours to several days, depending on the nature of your condition and your personal situation. It is best for family members and others who will care for you after hospitalization to be involved in this planning.