tampabay.com

A hospital stay can be hazardous to your health

By Dr. DAVID LIPSCHITZ, Special to the Times
Published February 27, 2007


Recently, my father-in-law, at age 88, came face to face with the dangers of hospitals.

He had developed a viral infection and after a restless night, he awoke somewhat disoriented. He was taken to the emergency room of one of San Diego's finer hospitals, where blood tests and an MRI of the brain were performed; the results were normal.

But because of some minimal confusion on his part, my father-in-law was admitted for observation. At that time he could walk, dress and feed himself.

Soon after his admission to the hospital, he told a psychiatric nurse that he consumed six martinis daily. Even though his wife assured the nurse this was not true, she prescribed 50 milligrams of Librium every six hours - a drug that can prevent the medical complications of alcohol withdrawal. This drug made him so drowsy that he was unable to get out of bed without help.

At his age, symptoms of alcohol withdrawal virtually never occur, and Librium at that dose should not have been prescribed.

Fortunately, after the first dose was administered, we insisted that the drug be discontinued. Had he received the second and third doses of Librium as prescribed, I doubt he would have survived.

Making matters worse for my father-in-law, for some reason we were not able to determine, he was given a large dose of a diuretic, which caused excessive fluid loss and made him more confused.

By four days into his stay, he was bed-bound, wearing a diaper and unable to feed himself. No one paid much attention to him, and because the food and water were placed too far away for him to reach, he did not eat or drink.

If his family had not been vigilant about his care or lack thereof, I suspect he would not have made it out alive.

He saw a different doctor every day and was rarely tended to by a nurse; only his family helped with feeding or drinking. We resolved to take care of him at home.

After a heated argument with his physician, we prevailed. He returned home, and a week later he was much improved.

Unfortunately, this story is not uncommon. Versions of it occur even at outstanding institutions throughout our country.

Most hospitals are not attuned to meeting the needs of older people, who can deteriorate rapidly if care is even slightly less than ideal.

Many factors contribute to poor care in hospitals:

- Budget cuts have led to significant reductions in the number of nurses per ward.

- Short staffing forces nurses to spend their time charting and administrating. Virtually no time is left for assisting patients.

- In many cases, patients are seen by physicians who have little or no prior knowledge of the patient's history or chronic conditions.

- Often, patients are confused; their families don't stay with them, increasing the risk of errors.

There are solutions. Incredibly few hospitals have Acute Care of the Elderly, or ACE, units. These are designed to ensure that older people don't stay in bed and that they do receive rehabilitation from the moment they are admitted.

Patients are often fed in a dining room. ACE units are staffed by nurses who understand the needs of older people. The benefits are proven: Patients are less likely to become dependent, have shorter stays and recover more quickly.

ACE units are easy to establish and are no more expensive than other units. It is scandalous that any hospital does not have a specialized ward to care for the very old.

If an older loved one of yours is admitted to a hospital, never leave this person alone. Trust no one, question every decision, make sure you understand what is being done and ensure that the attending physician fully appreciates all of the patient's problems.

You should make sure the patient gets out of bed (if possible), eats and drinks adequately and receives only prescribed medications, on schedule.

Every older patient needs an advocate who should be there at all times.

Gerontologist David Lipschitz holds both a medical degree and a Ph.D. and is the author of "Breaking the Rules of Aging." Write to him at askdrdavid@msn.com His Web site is www.drdavidhealth.com.