[Geriatrics at hospitals for acute diseases]

Almost half of adults who occupy hospital beds are > = 65 years; this proportion is expected to increase as the population ages. Hospitalization can magnify age-related physiologic changes and increase morbidity. The outcome of hospitalization appears to be poorer with increasing age; outcome is better in patients hospitalized for elective procedures (e.g., joint replacement) than in those hospitalized for serious conditions (e.g., multisystem organ failure). About 75% of persons > = 75 who are functionally independent when admitted to hospitals from their homes are not functionally independent when discharged. Even when an illness is treatable or appears uncomplicated, patients may not return to prehospitalized functional status. A particularly successful model is Acute Care for the Elderly (ACE) intervention, a program of patient-centered care designed to prevent dysfunction. Hospitalization is necessary only when the patient cannot receive appropriate treatment in any other environment. The health care practitioner should promptly identify patients who can benefit from medical care in another environment (e.g., at home). Acute hospital care should only be of sufficient duration to allow successful transition to home care, a skilled nursing facility, or an outpatient rehabilitation program.