Introduction
Older adults (OA) are at increased risk for adverse outcomes during hospitalization compared to younger populations. Physiological changes in aging and higher rates of chronic illness contribute to OA vulnerability in the hospital setting. Potential hazards include immobility, delirium, medication side effects, malnutrition, pressure injuries, hospital-acquired infections, and issues during surgical procedures and recovery. This paper will discuss three critical hazards for hospitalized older adults – delirium, pressure injuries, and postoperative complications. Evidence-based prevention strategies will be identified for each risk.
Delirium
Delirium is an acute change in mental status characterized by inattention, altered consciousness, and disorganized thinking (Inouye, 2021). Hospitalization increases older adults’ risk for delirium due to factors including medication side effects, immobility, sleep deprivation, dehydration, infection, and vision/hearing impairment. Up to 50% of hospitalized older adults experience delirium, which leads to poor outcomes, including increased mortality, more extended hospital stays, loss of independence, and higher rates of nursing home placement—strategies to prevent delirium focus on identifying and modifying risk factors. Routine cognitive screening using validated tools aids early detection of delirium (Mervis & Phillips, 2019). Maintaining hydration, bowel/bladder regimens, mobility, nutrition, vision aids, and hearing devices promotes normal function. Reorienting patients frequently and encouraging family presence also helps prevent delirium. Medication reconciliation upon admission and review for anticholinergic burden reduces deliriogenic medications. Non-pharmacologic sleep protocols optimize rest. Early infection identification and treatment are also recommended. A multicomponent approach combining these strategies effectively reduces delirium incidence during hospitalization.
Pressure Injuries
Pressure injuries, bedsores, or pressure ulcers are localized tissue damage caused by unrelieved pressure over a bony prominence. Hospitalized older adults have increased risk due to immobility, poor nutrition, incontinence, and medical devices. Pressure injuries lead to pain, infection risk, delayed healing, extended hospital stays, and reduced quality of life. Pressure injury prevalence in hospitalized older adults ranges from 12-38%. Prevention focuses on pressure relief and early detection (Mervis & Phillips, 2019). Turning/repositioning patients at least every two hours is essential, using lift devices to avoid friction. Support surfaces like specialized mattresses and heel protectors redistribute pressure. Keeping skin clean and dry prevents skin breakdown—adequate nutrition and hydration support tissue integrity. Daily skin assessment identifies early tissue damage so preventive interventions can be initiated. Involving family in turning/repositioning reminders and skin checks enhances compliance with these strategies.
Postoperative Complications
Older adults suffer disproportionately from postoperative issues, including pain, delirium, infection, cardiac events, and medication side effects. Advanced age is an independent risk factor for complications after surgery. Postoperative complications lead to more extended hospital stays, loss of independence, and increased mortality. Several evidence-based approaches reduce risk during the perioperative period. Preoperative evaluation of cardiac, pulmonary, and functional status allows optimization prior to surgery. Patient education on what to expect and early ambulation sets recovery expectations (Booka et al., 2018). Multimodal pain management strategies improve analgesia while reducing opioid side effects. Avoiding preoperative fasting and ensuring good hydration status prevents delirium. Antibiotic prophylaxis and hair clipping instead of shaving reduce surgical site infections. Postoperative delirium prevention protocols are key, using strategies like orientation, mobility, hydration, and non-pharmacologic sleep promotion. Early warning systems to identify deterioration allow rapid response to complications. A team-based geriatric-focused approach to surgical care improves outcomes in older adults.
Conclusion
In conclusion, hospitalized older adults are at high risk for issues like delirium, pressure injuries, and postoperative complications due to the interactive effects of illness, immobility, medications, procedures, and age-related physiological vulnerability. Utilizing evidence-based prevention practices reduces these risks. Clinical vigilance in the early identification of emerging issues is also essential. Multicomponent prevention initiatives focused on common geriatric syndromes demonstrate efficacy in improving care for hospitalized older adults. An interprofessional team approach is critical for optimal outcomes in this population.
References
Booka, E., Takeuchi, H., Suda, K., Fukuda, K., Nakamura, R., Wada, N., Kawakubo, H., & Kitagawa, Y. (2018). Meta-analysis of the impact of postoperative complications on survival after oesophagectomy for cancer. BJS Open, 2(5), 276–284. https://doi.org/10.1002/bjs5.64
Lauretani, F., Bellelli, G., Pelà, G., Morganti, S., Tagliaferri, S., & Maggio, M. (2020). Treatment of delirium in older persons: What we should not do! International Journal of Molecular Sciences, 21(7), 2397. https://doi.org/10.3390/ijms21072397
Mervis, J. S., & Phillips, T. J. (2019). Pressure ulcers: Pathophysiology, epidemiology, risk factors, and presentation. Journal of the American Academy of Dermatology, 81(4), 881–890. https://doi.org/10.1016/j.jaad.2018.12.069
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