When Frail Elderly Adults Get Sick: Alternatives to Hospitalization
Authors: Muriel R. Gillick
Journal: Annals of Internal Medicine (2014)

Ideas and Opinions4 February 2014When Frail Elderly Adults Get Sick: Alternatives to HospitalizationMuriel R. Gillick, MDMuriel R. Gillick, MDFrom Harvard Pilgrim Health Care Institute/Harvard Medical School, Boston, Massachusetts.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M13-1793 Annals Author Insight Video - Muriel R. Gillick, MD In this video, Muriel R. Gillick, MD, offers additional insight into her Ideas and Opinions piece, "When Frail Elderly Adults Get Sick: Alternatives to Hospitalization." SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Providing high-quality, cost-effective medical care to the sickest, oldest, and frailest patients remains a formidable challenge. The 18 million people older than 65 years with chronic conditions and limitations in their ability to carry out basic daily activities make up 6% of the noninstitutionalized U.S. population but consume 25% of total health care spending (1). The lion's share of these resources go to hospital care: 63% of Medicare patients with 6 or more chronic conditions are hospitalized each year (vs. 13% of those with 2 to 3 chronic conditions) and account for 70% of Medicare 30-day rehospitalizations (2). Although the ...References1. Alexcih L, Shen S, Chan I, Taylor D, Drabek J; The Lewin Group. Individuals Living in the Community with Chronic Conditions and Functional Limitations: A Closer Look. Washington, DC: U.S. Department of Health and Human Services; 2010. Google Scholar2. Centers for Medicare & Medicaid Services. Chronic Conditions Among Medicare Beneficiaries. Chartbook: 2012 Edition. Baltimore, MD: Centers for Medicare & Medicaid Services; 2012. Google Scholar3. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381:752-62. [PMID: 23395245] CrossrefMedlineGoogle Scholar4. D'Souza S, Guptha S. Preventing admission of older people to hospital. BMJ. 2013;346:f30186. CrossrefGoogle Scholar5. Creditor MC. Hazards of hospitalization of the elderly. Ann Intern Med. 1993;118:219-23. [PMID: 8417639] LinkGoogle Scholar6. Fox MT, Persaud M, Maimets I, O'Brien K, Brooks D, Tregunno D, et al. Effectiveness of acute geriatric unit care using acute care for elders components: a systematic review and meta-analysis. J Am Geriatr Soc. 2012;60:2237-45. [PMID: 23176020] CrossrefMedlineGoogle Scholar7. Fried TR, Tinetti ME, Iannone L, O'Leary JR, Towle V, Van Ness PH. Health outcome prioritization as a tool for decision making among older persons with multiple chronic conditions [Letter]. Arch Intern Med. 2011;171:1854-6. [PMID: 21949032] CrossrefMedlineGoogle Scholar8. Fromme EK, Zive D, Schmidt TA, Olszewski E, Tolle SW. POLST Registry do-not-resuscitate orders and other patient treatment preferences. JAMA. 2012;307:34-5. [PMID: 22215159] CrossrefMedlineGoogle Scholar9. Leff B, Burton L, Mader SL, Naughton B, Burl J, Inouye SK, et al. Hospital at home: feasibility and outcomes of a program to provide hospital-level care at home for acutely ill older patients. Ann Intern Med. 2005;143:798-808. [PMID: 16330791] LinkGoogle Scholar10. Meret-Hanke LA. Effects of the Program of All-inclusive Care for the Elderly on hospital use. Gerontologist. 2011;51:774-85. [PMID: 21737398] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Muriel R. Gillick, MDAffiliations: From Harvard Pilgrim Health Care Institute/Harvard Medical School, Boston, Massachusetts.Disclosures: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-1793.Corresponding Author: Muriel R. Gillick, MD, Department of Population Medicine, Harvard Pilgrim Health Care Institute/Harvard Medical School, 133 Brookline Avenue, 6th Floor, Boston, MA 02215; e-mail, muriel_gillick@hphc.org.Author Contributions: Conception and design: M.R. Gillick.Drafting of the article: M.R. Gillick.Critical revision of the article for important intellectual content: M.R. Gillick.Final approval of the article: M.R. Gillick. PreviousarticleNextarticle Advertisement Annals Author Insight Video - Muriel R. Gillick, MD In this video, Muriel R. Gillick, MD, offers additional insight into her Ideas and Opinions piece, "When Frail Elderly Adults Get Sick: Alternatives to Hospitalization." FiguresReferencesRelatedDetails Metrics Cited byChanging Hospital Care For Older Adults: The Case for Geriatric Hospitals in the United StatesFeasibility and Acceptability of Nurse-Led Primary Palliative Care for Older Adults with Chronic Conditions: A Pilot StudyIntegrated care at home reduces unnecessary hospitalizations of community-dwelling frail older adults: a prospective controlled trialTargeting Interventions and Populations 4 February 2014Volume 160, Issue 3Page: 201-202KeywordsDeliriumElderlyFallsGeriatricsHealth careHospitalizationsMedicareNursing homesPatientsQuality of life ePublished: 4 February 2014 Issue Published: 4 February 2014 Copyright & PermissionsCopyright © 2014 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...