'Post-hospital syndrome' could be increasing readmissions for older patients

After discharge, the stress of hospitalization can leave patients unsettled and weakened, a state called "post-hospital syndrome" that researchers say can contribute to readmissions in elderly patients, The New York Times reports.

About 18 percent of discharged Medicare beneficiaries returned to the hospital within 30 days in 2016, according to CMS data.

Harlan Krumholz, MD, a cardiologist at Yale University in New Haven, Conn., coined the phrase "post-hospital syndrome" in a 2013 New England Journal of Medicine article.

After CMS started to penalize hospitals for 30-day readmissions under the ACA, Dr. Krumholz analyzed national data and found most readmissions involved conditions that appeared to be unrelated to patients' initial diagnoses.

Patients were admitted with heart failure or pneumonia, received treatment and were discharged, then came back to the hospital with internal bleeding or injuries after a fall.

"Our general approach in a hospital is, all hands on deck to deal with the problem people come in with," Dr. Krumholz said. "All the other discomforts are seen as a minor inconvenience."

Dr. Krumholz  says discharge is the start of a 60- to 90-day period of more vulnerability to various health problems for these patients that come from the stress of hospitalization.

Dr. Krumholz and his fellow researchers tracked discharged Medicare patients after hospitalizations for heart failure, heart attacks and pneumonia, and found readmissions for gastrointestinal bleeding and anemia peaked four to 10 days after discharge, according to a study in PLOS One. And the risk of trauma from falls or other accidents, stayed elevated for three to five weeks, the study found.

But making hospitals less destabilizing and more conducive to healing, appears to be achievable. Hospitals do it for children, Dr. Krumholz said, and some hospitals offer less stressful environments for older patients, including specialized geriatric emergency rooms.

To help mitigate post-hospital syndrome, hospitals can create policies that encourage older patients to wear their own clothes, take walks and eat enough to maintain their weight.

As hospitals work to adopt these policies, families can bring relatives their favorite foods, help them eat and ensure they have their hearing aids and walkers to help them stay oriented.

But Dr. Krumholz said it's not fair to put all the responsibility of helping patients adjust on families.

"It should come from the institution," he said.

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