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**Understand older adult risks when hospitalized** Ideal outcomes: - Complications avoided, maintenance of functional and mental status, minimal weight loss, pain, anxiety minimized, improved communication to and from patient with healthcare team Hospital environment: - Deconditionin...

**Understand older adult risks when hospitalized** Ideal outcomes: - Complications avoided, maintenance of functional and mental status, minimal weight loss, pain, anxiety minimized, improved communication to and from patient with healthcare team Hospital environment: - Deconditioning occurs rapidly: muscle weakness, atrophy, venous stasis - Immobility - Poor oral hygiene - Sleep deprivation - Pain - Nutritional status declines - Polypharmacy - depression Other risks from the hospital: high risk meds, noise, stimuli, tubes drains, leads, wires, IV catheters, invasive procedures, shear, friction, bedrest, infection control Delirium risk factors: - Advancing age, dementia/ cognitive impairment, comorbidities, medications, sensory impairments, unplanned surgery, fracture on admission RF for independence in older adults: lives alone, age, sensory impairment, medical history, cognitive impairment, functional status, mobility, pain, IADLs, ADLs Nurses role in a hospitalized older adult: assessment, communication, medication reconciliation, family presence, professional RN role, what matters most - Admission assessment: older adult, pain, functional status, nutrition, med rec, 4Ms, neurovascular, injuries, Comprehensive geriatric assessment 90% take meds, 39% take 5+, 90% take OTC, ADE most common type of iatrogenesis, 2.5x more likely to have med reaction Polypharmacy and Beers list: clinical tool to help provide guidance for patients and health care workers about medications for older adults, identifies at risk medications, warning light, improves medication selection, reduce adverse effects, tool for care BENZOS, DIURETICS, BARBITURATES - Goals: improve the care of older adults by reducing their exposure to potentially inappropriate meds (PIMS) Functional Decline: - 30-60% of older adults suffer functional decline - Increased dependency, decreased autonomy, decreased QOL, increased length of stay, increased risk for readmission, increased risk for home health, increased risk of care giver strain Surgical Risk factors: hearing and vision impaired, cognitive decline, family presence, informed consent - Informed consent: comprehension of the information provided (by the surgeon) is a precondition for informed consent, nurses can repear back after discussion with surgeon, process is complex with cognitive decline and sensory impairment **Discuss nutrition risks for older adults when hospitalized.** **Lack of appetite, reduction of taste buds, hospital food (grossss!!), delirium (unable to determine day/time)** **Identify nursing interventions that best mitigate complications, iatrogenesis, and functional decline for hospitalized older adults, especially during transitions in care.** Iatrogenesis is the term used to describe any harm or illness that results from medical care, including diagnosis, intervention, error, or negligence Older adults and Iatrogenesis: diminished physiologic reserve, inability to compensate, atypical presentation, multi comorbidity and chronicity, polypharmacy, cognitive impairment, functional impairment - Unintended and untoward consequences of healthcare interventions - Example: adverse drug reactions, adverse procedure reactions, nosocomial condition, falls, common and PREVENTABLE - Always avoid: barbituates, flurazepam, meprobamate, chlorpropamide, meperidine, pentazocine, trimethobenzamide, belladonna alkaloids, dicyclomine, hyoscyamine and propantheline - Cascade: series of adverse events triggered by HCP interventions initiating a cascade of decline, occurs with older, functional impairment, high severity of illness - The average hospitalized patient is subject to at least one medication error per day - Team: nurse, pharmacy, physician Medication reconciliation: formal process, comparing a patients medications to all the medications that the patient has been taking, three disciplines are involved, patient acuity influences history, no standardization of process - Works to avoid errors of omission duplication, incorrect dosing or timing or adverse drug-drug or drug-disease interactions, must occur at ALL TRANSITIONS ala changes in setting, service, practitioner or level of care, brown bag approach from home 1. Develop a list of current medications 2. Develop a list of medications to be prescribed 3. Compare the medications on the two lists 4. Make clinical decisions based on comparison 5. Communicate the new list to appropriate caregivers and to the patient Medication administration: complex multistep, who, what, when, where, why - Right patient, drug, dosage, time, route, reason, education, documentation, refusal, evaluation - Be aware of system concerns norms of institutions (override, stocking), staffing, fatigue, distractions, culture of safety, advocate for safer practices - ALMOST HALF OF ALL MEDICATION ERROS OCCUR DURING HOSPITAL ADMISSION OR DISCHARGE Transitions in healthcare: movement of a patient from one set of providers, level of care or health care setting to another - Other term: handoff, handover and transfers - Can occur within the hospital setting or across health care settings - Almost 40% of older adults experience \>2 transitions within 30 days of hospital discharge - 1/5 adults discharged from hospital and rehospitalized within 30 days, 1/3 rehospitalized within 90 days - 22% medicare patients have one transition in a year - 15 billion medicare charged for readmission - Half of med errors occur during the transition at admission and discharge CGA helps mitigate iatrogenesis, early mobility, prevention of delirium, fall prevention, nutrition, patient family education Skin breakdown, problems eating, incontinence, confusion, evidence of falls, skin breakdown Atypical pres: confusion, no fever, increase in falls (accidents) Inaccurate or incomplete information can result in - Delayed diagnosis, duplicative medical services, hospital readmission, reduced patient and provider satisfaction **Understand how common medical conditions and geriatric syndromes in older adults' impact health outcomes** Barriers to health: SDOH, multiple meds, costs, homelessness, food insecurity, limited income, literacy, health literacy, distrust of HCP Hypertension: increased risk of rCV, CKD, death, cognitive decline, stroke, dementia if untreated, international guidelines consider- multicomorbidity and QOL, SBP\

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