title: Making hospitals safer for older adults: updating quality metrics by understanding hospital-acquired delirium and its link to falls.
abstract: The medical care of hospitalized geriatric patients must differ from the care of younger adults. Because of reduced "reserve capacity," hospitalized older adults are at high risk of development of geriatric syndromes such as delirium and falls. Geriatric syndromes often lead to functional decline and dependence. Patients who experience geriatric syndromes in the hospital are more likely to have a longer length of stay, higher risk of readmissions, and worse medical outcomes. Incident delirium in hospitalized geriatric patients has been shown to be preventable by intervening in established risk factors. Prevention of hospital-related falls has not been consistently demonstrated. Analysis from Kaiser Permanente data demonstrated a correlation with delirium and hospital-related falls. We propose that age-specific quality metrics should be made to reduce the risk of the development of geriatric syndromes in hospitalized older adults. By preventing delirium, we believe that health care practitioners can reduce hospital-related falls in geriatric patients and improve the quality of care delivered to hospitalized older adults. An illustrative fictional case study is presented.
authors.affiliation: Assistant Chief of Internal Medicine at the West Los Angeles Medical Center and former Chair of the Southern California Permanente Medical Group Geriatric Hospital Safety Committee in Los Angeles. eric.a.lee@kp.org.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Lee
authors.affiliation: Regional Coordinating Chair for Geriatrics and Continuing Care for Kaiser Permanente Southern California in Pasadena. nancy.e.gibbs@kp.org.
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Gibbs
authors.affiliation: Regional Director of Quality and Patient Safety for Patient Care Services for Kaiser Permanente Southern California in Pasadena. linda.x.fahey@kp.org.
authors.forename: Linda
authors.initials: L
authors.lastname: Fahey
authors.affiliation: Quality and Patient Safety Consultant for Patient Care Services for Kaiser Permanente Southern California in Pasadena. teri.l.whiffen@kp.org.
authors.forename: Teri L
authors.initials: TL
authors.lastname: Whiffen
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D003693:Delirium / Q000517:prevention & control*; D003695:Delivery of Health Care / Q000592:standards*; D015577:Geriatric Assessment; D006760:Hospitalization; D006761:Hospitals / Q000592:standards*; D006801:Humans; D061214:Patient Safety / Q000592:standards*; D011785:Quality Assurance, Health Care; D012307:Risk Factors