[SPEAKER_00]: Mrs.

Aging Ford, a podcast from Mayo Clinic about the science behind healthy aging and longevity.

[SPEAKER_00]: Each episode, we explore new ways to take care of our long-term health, the health of our loved ones, and our community, so it can all live longer and better.

[SPEAKER_00]: I'm Dr.

Christina Chen, a geriatrician and internist at Mayo Clinic in Rochester, Minnesota.

[SPEAKER_00]: In this episode, we are talking about hospital stays, and how to return home safely.

[SPEAKER_00]: Every year there are about a thirteen point two million hospitalizations for adults sixty five years and older in the United States, including for medical conditions, surgeries, injuries, and other things we often don't think about, like medication side effects, or dementia related situations.

[SPEAKER_00]: Hospitalization saves lives, but there are many things that occur during the stay and other hidden risks that can impact outcomes as well, especially for the older adults.

[SPEAKER_00]: So here to talk about that today is Dr.

Ellison Palmer, who was an interness in Jared Trishon at Mayo Clinic in Rochester, Minnesota.

[SPEAKER_00]: She practices mainly as a hospitalist, but has many other talents and interests, including leading cutting-edge research and aging mechanisms and therapeutic targets and managing delirium.

[SPEAKER_00]: She's also a leader in program director for the Mayo Clinic Medical School, Geriatric's curriculum, and has worked with learners across all levels.

[SPEAKER_00]: So thank you so much for being here today, Dr.

Palmer.

[SPEAKER_00]: Thank you for having me.

[SPEAKER_00]: You know, part of the reason why I just can't work in the hospital full time is because of the acuity factor.

[SPEAKER_00]: It's just so hard to see people at their worst every day.

[SPEAKER_00]: And it can be very heartbreaking.

[SPEAKER_00]: But at the same time, you can also see them get better and go home.

[SPEAKER_00]: And there's so many reasons why people are hospitalized for different health needs.

[SPEAKER_00]: What are the most common reasons that older adults find themselves in the hospital?

[SPEAKER_01]: I would say hospitalizations for older adults can probably be put into about five buckets.

[SPEAKER_01]: One would be sudden events, cardiovascular events like heart attacks and strokes.

[SPEAKER_01]: A second one would be worsening of chronic medical conditions such as heart failure or COPD.

[SPEAKER_01]: A third category would be infections, most commonly pneumoniaes or urinary tract infections.

[SPEAKER_01]: And then a fourth would be accidents or trauma.

[SPEAKER_01]: And these are the patients that I often see on our consult service where we're helping our trauma surgeons care for older adults who have come in because of a fall or a motor vehicle accident with multiple injuries.

[SPEAKER_01]: And then a fifth category may be not the most common, but another reason that older adults are hospitalized would be after an elective surgery.

[SPEAKER_01]: If that surgery requires some monitoring then an older adult may have a hospital stay for that reason.

[SPEAKER_00]: Why is it riskier for older adults to be in the hospital compared to someone in their twenties?

[SPEAKER_00]: What makes it so much harder for them?

[SPEAKER_01]: So older adults often have existing factors that increase their risk for adverse events during a hospitalization.

[SPEAKER_01]: One of which would be long-term medical conditions that might make certain organ systems more susceptible to damage or require medications that could interact with treatments that are given in the hospital that could lead to adverse drug events.

[SPEAKER_01]: older adults may also have functional impairments that are pre-existing, such as mobility limitations or cognitive impairment that could increase their vulnerability to hospital acquired complications.

[SPEAKER_01]: For example, limited mobility in the hospital could lead to the development of pressure ulcers that are difficult to treat.

[SPEAKER_01]: Being in the hospital also puts us at risk of nosicomial infections or infections that are required just because of being in the hospital.

[SPEAKER_01]: That's a risk that is present for everyone, but older adults are at increased risk because it preexisting conditions.

[SPEAKER_00]: Right.

[SPEAKER_00]: Right.

[SPEAKER_00]: But then when they're in the hospital, how does being in the hospital impact their function even further?

[SPEAKER_01]: So I think a lot of folks might be surprised to hear the answer to this question, how long do you think that patients are out of bed when they're in the hospital in a typical, twenty four hour period?

[SPEAKER_01]: It's less than one hour.

[SPEAKER_01]: And so if we contrast that to how we are in our own homes, our mobility in the hospital is just severely reduced because of the nature of a hospitalization.

[SPEAKER_01]: We assign patients beds, not rooms.

[SPEAKER_01]: And I think a lot of folks feel like if I'm sick enough to be in the hospital, then I better stay in bed and not move a whole lot.

[SPEAKER_01]: Whereas the evidence shows early mobility is paramount to [SPEAKER_01]: not losing function while in the hospital and to a good recovery.

[SPEAKER_01]: So the effects of a hospitalization are exacerbated if someone is coming in with already limited mobility because we know that a hospitalization itself puts us at risk of worsening mobility and functional impairments.

[SPEAKER_01]: It's common for older adults who actually develop a new impairment in activities of daily living that they didn't have prior to a hospitalization.

[SPEAKER_01]: And if we think about that, it's actually, it's very scary because it can cause folks to need more assistance when they leave the hospital, either needing the assistance of another person or possibly needing an increased level of care, like needing to go to a acute rehabilitation center.

[SPEAKER_00]: It's interesting because I think when most people go to the hospital, they think, oh, I'm sick.

[SPEAKER_00]: Therefore, I need to rest and recover and I need to take as much time to heal my body and therefore, I shouldn't be doing too much.

[SPEAKER_00]: When it's actually the opposite, we should try to get you up and moving as much as possible while you're getting the treatment and recovery.

[SPEAKER_00]: It's helpful to try our best to get back to our baseline as much as possible as early as possible.

[SPEAKER_00]: Can you describe this term post-hospital syndrome?

[SPEAKER_00]: We hear that a lot.

[SPEAKER_00]: What does that mean?

[SPEAKER_00]: And how does that affect recovery?

[SPEAKER_01]: So post-hospital syndrome is a transient period of generalized health vulnerability following an acute hospital admission.

[SPEAKER_01]: And this syndrome involves physiologic deconditioning due to various stressors that are experienced during the hospital stay, such as disrupting the circadian rhythms, nutritional depletion, and the just physical and psychological stress of the hospital and swimming itself.

[SPEAKER_01]: And so this post-hospital syndrome can really impact recovery by increasing the risk of adverse outcomes after discharge and patients with post-hospital syndrome are more likely to experience higher rates of hospital readmissions.

[SPEAKER_01]: They can have longer lengths of stay while in the hospital and have increased risk of post-operative complications.

[SPEAKER_00]: Yeah, I think just any time you're out of your normal state of living, and then I'll send you having so many things happen to you being on new medications and new diagnosis.

[SPEAKER_00]: It's got to be hard to be able to do that.

[SPEAKER_00]: It can be very overwhelming, right?

[SPEAKER_00]: So let's talk a little bit about while we are in the hospital and kind of navigating a hospital stay, practical tips to doing this well.

[SPEAKER_00]: A lot of things happen during a hospitalization, you know, and discharge summaries.

[SPEAKER_00]: We see people going with one thing and then they come out with fifteen other things.

[SPEAKER_00]: You know, it's not simple as just being treated and then going home.

[SPEAKER_00]: You just grab like a average hospital stay for you.

[SPEAKER_01]: I would say there is no average hospital stay and it can be difficult to know what to anticipate coming into the hospital especially if you've never been hospitalized before.

[SPEAKER_01]: There's a lot going on.

[SPEAKER_01]: There's the acute treatments.

[SPEAKER_01]: There's the new environment interaction with lots of different medical staff and team members.

[SPEAKER_01]: And so I think there are a lot of factors that it's helpful to know about, especially as a caregiver or loved one of somebody who is being hospitalized, a couple of things that I think it might be helpful to just anticipate.

[SPEAKER_01]: It's important to have a good grasp of medications that someone is on because it's so common that older adults are on multiple medications when they come into the hospital that medication reconciliation is paramount to understanding their condition before they came into the hospital and knowing what changes might be necessary or appropriate to make during the hospital stay.

[SPEAKER_01]: So not only having the medication list that's up to date of what the person has been taking at home [SPEAKER_01]: But knowing of any recent changes, noting if there have been any changes in your loved one after a medication change for example is helpful.

[SPEAKER_01]: It's also important to know that as a loved one or caregiver, you are kind of the eyes and ears in that hospital room.

[SPEAKER_01]: And it's important for your medical team to know if you're noticing anything that seems abnormal in your loved one.

[SPEAKER_01]: If you're noticing that they're seeming, not themselves, they seem confused, they're more anxious, they're more sleepy than they typically are.

[SPEAKER_01]: It's important to alert the medical team because [SPEAKER_01]: These subtle changes can alert us that something is developing, such as delirium.

[SPEAKER_01]: We talked a little bit about mobility being a difficulty during hospitalizations, but I think that this is an opportunity where patients and their caregivers or loved ones can be advocates or increase mobility because in a busy hospital environment, it is sometimes difficult for the care team to prioritize mobility, but it's something that we all want to work on.

[SPEAKER_01]: And so being an advocate for yourself and saying, my goal is to do three walks today, can you come with me and take that walk into the hallway?

[SPEAKER_01]: Because I know it's so important for my recovery.

[SPEAKER_01]: And then I think it's also important to consider as the hospitalization progresses.

[SPEAKER_01]: What things will be needed after discharge?

[SPEAKER_01]: And if things are looking different, if there are some new impairments or reasons why rehabilitation is necessary, how are we going to accomplish that?

[SPEAKER_01]: Can we do that in the home?

[SPEAKER_01]: Are we going to need an acute rehab stay?

[SPEAKER_01]: And just thinking about those things in the beginning of a hospitalization so that we can continue to talk about them with the multi-disciplinary team and really plan for [SPEAKER_01]: success after the hospital today.

[SPEAKER_00]: Yeah, I love that these are all such great tips and tools for the caregivers to advocate for their loved ones.

[SPEAKER_00]: I feel like there's always so many different conversations happening behind the scenes.

[SPEAKER_00]: You know, the patient in the caregiver and then you get the medical team and everyone's [SPEAKER_00]: doing their rounds at different times of the day.

[SPEAKER_00]: You know, it could be anytime from six a.m.

[SPEAKER_00]: to four p.m.

[SPEAKER_00]: you just gotta try to catch them at the right time.

[SPEAKER_00]: And you just never know when that's gonna be.

[SPEAKER_00]: Do you have any tips on how we can cohesively bring these conversations together?

[SPEAKER_00]: And how do we catch people in their rounds so we can bring the care coordination together?

[SPEAKER_01]: This is so tough.

[SPEAKER_01]: I think everyone would love to all be in the same room in a lot of times.

[SPEAKER_01]: It just isn't possible during a busy hospitalization, but I think just pursuing that communication and knowing who your touch points are.

[SPEAKER_01]: So the bedside nurse will always be the go-to in terms of raising new concerns.

[SPEAKER_01]: asking to talk with different members of the interdisciplinary team, such as the clinician or let's say you want to talk to the physical therapist or the social worker.

[SPEAKER_01]: The bedside nurse can really be the one who connects you with those individuals.

[SPEAKER_01]: It's also important when not inside the hospital walls to know how to contact the team.

[SPEAKER_01]: And so I think it's important on admission to know what's the phone number for the nursing unit where your loved one is staying.

[SPEAKER_01]: How do I get a hold of the nurse or the care team?

[SPEAKER_01]: And then how will the care team get in contact with you?

[SPEAKER_01]: So writing your name somewhere that's visible in the room.

[SPEAKER_01]: Maybe there's a white board where you can write your name, what relationship you are to the patient and then your phone number so that if anyone wants to get a hold of you, they can do that.

[SPEAKER_01]: In terms of timing and rounds, this can be really tricky because even if a time is kind of set, things can change quickly in a hospital environment.

[SPEAKER_01]: So while it can be helpful to kind of discuss that with the care team, sometimes you'll still miss each other.

[SPEAKER_01]: But I think it's important to know that it's okay to be an advocate for [SPEAKER_01]: the knowledge that you need to take care of your loved one and to be involved in their care.

[SPEAKER_01]: And so it's always all right to ask for some more communication.

[SPEAKER_01]: If there's more clarity that's needed asking for a team member to come by when they have a chance.

[SPEAKER_01]: That's something that I hope that folks are empowered to do.

[SPEAKER_00]: Yeah, it seems like there is plenty of opportunity for [SPEAKER_00]: technology to intervene in the space somehow.

[SPEAKER_00]: You know, we have televisors.

[SPEAKER_00]: We've got video options.

[SPEAKER_00]: We've got FaceTime, like, just dial in, call in.

[SPEAKER_01]: And we are starting to use some of those technologies in the hospital, such as virtual rounds in the afternoon, where clinicians can just pop in on a video screen to touch base and see if there are any questions from the morning's discussions.

[SPEAKER_01]: I think that can be really helpful.

[SPEAKER_01]: And it's always okay for a patient to call in a family member while the team is in the room, just say, just gonna take me a second to get my daughter on the phone or my spouse on the phone because I want them to hear this too.

[SPEAKER_01]: I think four years is better than two.

[SPEAKER_01]: And it's okay to do that.

[SPEAKER_01]: Great tips, I love it.

[SPEAKER_00]: must talk about infections, hospital and quite infections.

[SPEAKER_00]: Like you mentioned, no succumbion infections.

[SPEAKER_00]: I can't tell you how many times my patients don't want to go to the hospital because they're worried.

[SPEAKER_00]: I'm going to come out with three other things.

[SPEAKER_00]: You know, what are some ways we can reduce that risk of contracting hospital quite infections?

[SPEAKER_01]: This is tough.

[SPEAKER_01]: I would say that the same precautions that we use outside of the hospital should be used in the hospital.

[SPEAKER_01]: Of course, hand hygiene should be used all times.

[SPEAKER_01]: If you have any visitors who would like to see you, but are not feeling their best, they should probably stay out of the hospital.

[SPEAKER_01]: Really, what we aim to do is reduce the length of hospitalization because we know that a prolonged hospital stay increases your risk of developing those infections.

[SPEAKER_01]: So the least amount of time we can spend in the hospital is better in terms of lowering infection risk.

[SPEAKER_01]: And otherwise, it's keeping those same precautions that you would use outside of the hospital.

[SPEAKER_00]: Right.

[SPEAKER_00]: Trying to get in and get out quick.

[SPEAKER_00]: Yeah.

[SPEAKER_00]: Take those tubes out quick.

[SPEAKER_00]: Exactly.

[SPEAKER_00]: Now, let's talk about trying to avoid that hospitalization.

[SPEAKER_00]: Sometimes we just can't avoid it.

[SPEAKER_00]: If you're sick and you are clearly declining, we have to go and get treated or else it could lead to a terrible outcome.

[SPEAKER_00]: Are there ways we can take proactive steps to foresee what's coming and prevent a hospitalization in the first place?

[SPEAKER_01]: I think there are several good things to talk about in this space.

[SPEAKER_01]: So having a good relationship with a primary care provider, I think is one way to prevent hospitalizations, just having someone that knows you well is keeping tabs on your medications and your chronic medical conditions and can be that touch point for when things seem a little bit off when you notice something has changed before we get into that urgent emergent situation.

[SPEAKER_01]: It's important to have those regular visits with your doctor to review your medications.

[SPEAKER_01]: For example, medications that we take earlier in life can affect as much differently as we age.

[SPEAKER_01]: And so even medications that we've been on for ten, twenty, thirty years may require a little bit of adjustment as we age.

[SPEAKER_01]: And it's important for us to keep those touch points with a doctor who understands those age-related effects.

[SPEAKER_01]: and how to reduce risks of medications specifically.

[SPEAKER_01]: Another is really trying to optimize our physical functioning, keeping on top of regular physical activity, whether that's aerobic exercise, balance training, yoga, just to improve our mobility, our strength so that we are as resilient as possible in the event that we were faced with a hospitalization.

[SPEAKER_01]: If our functioning is better going into a hospitalization, we'll be better able to deal with the stresses of that hospitalization.

[SPEAKER_00]: Yeah, I love that.

[SPEAKER_00]: A lot of these are very sounds simple, but hard to do prevention strategies of not just something you're doing weeks to months prior.

[SPEAKER_00]: It's our lifestyle really exactly and working with your care provider to understand way early on.

[SPEAKER_00]: What are your risks right now?

[SPEAKER_00]: What can we do to effectively [SPEAKER_00]: manage those risks to prevent that like a vulnerable state when you start to decline.

[SPEAKER_01]: Exactly.

[SPEAKER_01]: And I think fall prevention is one of those two.

[SPEAKER_01]: You see so often, older adults coming in with falls and we're surprised at the extent of injuries that they might have because of those falls.

[SPEAKER_01]: And knowing that if you fall in in the past twelve months, you're at increased risk of future falls.

[SPEAKER_01]: then it's important to have that touch point and say, okay, what are the domains in which we can reduce your fall risk?

[SPEAKER_01]: Are there medications at play?

[SPEAKER_01]: Are there lifestyle factors like alcohol intake, for example?

[SPEAKER_01]: Are there risky things that we're doing like climbing on ladders when we maybe should be asking a family member for help?

[SPEAKER_01]: Are there loose rugs in our house?

[SPEAKER_01]: Are there things that we can do to mitigate fall risk?

[SPEAKER_01]: Just because we know that it's associated with such a high injury rate in older adults and can lead to hospital stays.

[SPEAKER_00]: And I guess you can plug in any health condition in there.

[SPEAKER_00]: You know, you mentioned falls, but if someone's at higher risk of having recurring heart failure exacerbations, looking at how much salt and take care.

[SPEAKER_00]: Exactly.

[SPEAKER_00]: They're consuming or, you know, how much fluid and just understanding what feeds into the risk of decline.

[SPEAKER_00]: You mentioned earlier, [SPEAKER_00]: caregivers and family members in the hospital when you notice something's off to notify the care team.

[SPEAKER_00]: How about warning signs in the outpatient setting?

[SPEAKER_00]: What are other symptoms or warning signs that caregivers should keep track of to prevent an emergency hospitalization?

[SPEAKER_01]: loved ones or caregivers are gonna be the ones who notice subtle changes that may not be obvious to others even somebody's physician and so really keeping an eye out for any changes in your loved one if something seems off or different just not taking it lightly and mentioning that to the care team and saying is there something that could be underlying this and I especially think of this in [SPEAKER_01]: persons with dementia because the most subtle changes can be a harbinger of underlying medical conditions that are developing, like infections, for example, just disruptions in sleep or more anxiety or agitation or new hallucinations behaviors that are just different from what is expected at baseline could be an indicator that something is very wrong.

[SPEAKER_01]: And so saying something early rather than waiting for an urgent [SPEAKER_01]: situation to develop.

[SPEAKER_01]: I think you made a great point about prior hospitalizations related to things like COPD or heart failure.

[SPEAKER_01]: If we know you've had an exacerbation in the past, leading to a hospitalization or nearly needing a hospitalization, it's important to say early, okay, if my legs are swelling, I'm going to call my doctor and try to address the situation before it leads to something that's unmanageable.

[SPEAKER_01]: I think it's that spidey sense.

[SPEAKER_01]: It's always striking when you hear a family member say, this isn't my mom.

[SPEAKER_01]: This isn't my family member.

[SPEAKER_01]: Something is not right.

[SPEAKER_01]: How often we do find that there's, you know, a new infection brewing or there is delirium that's starting to manifest that we haven't identified clinically.

[SPEAKER_01]: And so I just always find it very important to listen to caregivers in the hospital because so often they [SPEAKER_01]: No, something is happening before we do.

[SPEAKER_00]: I know this is a big topic and it's probably an entire discussion on its own, but this sort of comes off of the example earlier you mentioned about when someone has dementia and they can't really tell you what's going on so we're [SPEAKER_00]: having to kind of guess, but also understanding one's goals in their advanced care planning is important too.

[SPEAKER_00]: That's something that I know as soon as someone's in the hospital, we're looking at advanced care planning to see what is someone's wishes before that things happen.

[SPEAKER_00]: Can you talk about the importance of that and how does just discussing goals of care help reduce unnecessary hospital stays?

[SPEAKER_01]: This is such an important area and I think it's an area that can be very uncomfortable to talk about, especially when we're feeling well.

[SPEAKER_01]: Things are going well.

[SPEAKER_01]: We don't feel like it's something we need to think about, but it can be so valuable to speak with your family members or your caregivers or loved ones about what you would want.

[SPEAKER_01]: Should there be an emergency?

[SPEAKER_01]: Should there be a hospitalization or should your condition decline?

[SPEAKER_01]: And I think as geriatricians, we focus on the four M's, one of which is what matters most.

[SPEAKER_01]: And talking to somebody about what matters most can really help us understand what they might want in a serious situation like a hospitalization.

[SPEAKER_01]: And in fact, [SPEAKER_01]: In certain situations, folks may not even want to go to the hospital, and that's important for us to address too.

[SPEAKER_01]: There are other options in terms of care that you can receive, and that can include care at home.

[SPEAKER_01]: In some cases, [SPEAKER_01]: If you've had recurrent hospitalizations and that's causing more stress and leading you farther and farther from what matters most, it's so important for us to have those discussions to make sure that the care that we're giving in the hospital is concordant with what matters most to you what you want.

[SPEAKER_01]: It's just important to have those discussions.

[SPEAKER_00]: As early as possible, really.

[SPEAKER_01]: We before and if possible, write those things down.

[SPEAKER_01]: Let's say we've had a heart failure exacerbation and we've gotten that person through that episode.

[SPEAKER_01]: Things are looking good.

[SPEAKER_01]: They're about to go home.

[SPEAKER_01]: Going to spend time with their family again, doing the things that matter most to them.

[SPEAKER_01]: That is a good time to talk about what we would do next time.

[SPEAKER_00]: I think we come in here of the DNR, DNR, DNR, I do not resuscitate, I do not intubate, but we forget to offer the opportunity of doing not hospitalized because if you're sick of going to the hospital and you don't want to go back there anymore because each time you come out you don't get better and your wishes are to be at home in the most comfortable setting with your family.

[SPEAKER_00]: That should be an option too, absolutely.

[SPEAKER_01]: It can be so freeing for family members to know in advance what you would want so that they can be there for you as family members or as caregiver rather than having to grapple with this decision when they're not sure what you would want.

[SPEAKER_01]: It's just such a more peaceful [SPEAKER_01]: situation for everyone and can really take that burden off of your loved ones.

[SPEAKER_00]: Yeah, let's spend some time to talk about delirium because this is a big problem.

[SPEAKER_00]: We see this very commonly, especially in older adults when they're very ill.

[SPEAKER_00]: What is hospital-quired delirium?

[SPEAKER_00]: Why is it so common in older adults?

[SPEAKER_00]: And why is it so dangerous?

[SPEAKER_01]: So delirium is a sudden disturbance in cognition, orientation, and attention that can fluctuate over time.

[SPEAKER_01]: And it's associated with acute medical conditions like infections or heart attacks, but can also be brought on by stresses of the hospitalization itself, or, for example, a surgical procedure.

[SPEAKER_01]: There are different types of delirium, hyperactive, hyperactive delirium.

[SPEAKER_01]: And sometimes it looks like somebody is just tired.

[SPEAKER_01]: Delirium is extremely common in older adults and can affect up to fifty percent of older adults in certain cases, such as after open heart surgery, for example.

[SPEAKER_01]: And we know that delirium leads to increased risk of adverse events, including mortality, [SPEAKER_01]: falling in the hospital need to discharge to skilled nursing facilities and actually increase as risk of being diagnosed with dementia in the future.

[SPEAKER_01]: Delirium is associated with a more precipitous decline in cognitive function in the long term.

[SPEAKER_00]: Anything that affects your brain health is just devastating when there is a risk of it being permanently lingering even after your hospitalization and it never allows you to regain your cognitive function.

[SPEAKER_00]: Exactly.

[SPEAKER_01]: We oftentimes say that delirium is a medical emergency because it should be an indication to us that there may be something underlying that's reversible and we need to go looking for any causes of delirium.

[SPEAKER_00]: So I imagine there's probably a lot of research into how do we prevent this from happening or what do we do to not just screen it, but what are some ways that we can prevent and manage to learium?

[SPEAKER_01]: So the evidence tells us that the most effective intervention to prevent or reduce the length and severity of delirium is a bundle of interventions, including reorientation, promoting sleep hygiene, early mobility, and addressing sensory impairments.

[SPEAKER_01]: individually these are very simple interventions that tend to get overlooked during a busy hospitalization, but as a group can reduce delirium by thirty to forty percent.

[SPEAKER_00]: So that can be something our care providers can be aware of as well if we [SPEAKER_00]: Keep people oriented.

[SPEAKER_00]: Make sure they've got their hearing aids and glasses on at all times.

[SPEAKER_00]: Make sure they've got their hydration needs and nutrition needs.

[SPEAKER_00]: Keep their shades up, get the moving.

[SPEAKER_00]: These are all simple things that we can do just in the environment.

[SPEAKER_00]: We don't have to have a whole medical team coming every day to implement this.

[SPEAKER_00]: We can do this by bedside.

[SPEAKER_00]: Exactly.

[SPEAKER_00]: Alright, let's talk about getting people home and a guide to safe recovery.

[SPEAKER_00]: Ideally, we want them to go home as quickly as possible.

[SPEAKER_00]: Like you mentioned, shorten the hospital stay and then ideally to be able to get back to their baseline and better than baseline if possible.

[SPEAKER_00]: But the discharge process, it drives me nuts.

[SPEAKER_00]: The discharge summary is sometimes I read it unlike [SPEAKER_00]: This is just not what happened.

[SPEAKER_00]: You know, that discharge process is so critical.

[SPEAKER_00]: Can you talk a little bit about that?

[SPEAKER_00]: Like, what are the key elements to a discharge process?

[SPEAKER_01]: I think the key to a good discharge is really communication.

[SPEAKER_01]: And you mentioned that discharge summary, it's important for us as hospital providers to really convey the main points of the hospitalization, the ten thousand foot view of what was important, what was addressed, and what was changed.

[SPEAKER_01]: And I think in particular, [SPEAKER_01]: talking about what medications were changed or stopped or added and why, what the reasoning was, and if there's any plans for example to discontinue a medication or to taper a medication so that it's clear to not only the patient, but outpatient providers what the plan is going forward and the reasons why any changes were made.

[SPEAKER_00]: Any other key questions that caregivers should be asking before someone is sent home, what else should we be thinking about?

[SPEAKER_01]: I think it's helpful to just think through your day at home with your loved one after discharge.

[SPEAKER_01]: Look at the things that are happening during the hospitalization is there a new tube, like a fully catheter that needs care at home.

[SPEAKER_01]: Is there a new medication that needs to be given at a specific time?

[SPEAKER_01]: And whether there's anything that you need to be successful in the home setting, are there any supplies that you need, where the prescription's gonna be sent that's convenient for you.

[SPEAKER_01]: Do you need anyone to come in and do wound care?

[SPEAKER_01]: Are there services that need to be set up prior to discharge?

[SPEAKER_01]: And then I also think it's important to think about follow-up appointments.

[SPEAKER_01]: Are there specialty teams that have been involved during the hospitalization that you need to follow up within the outpatient setting and who is going to be making those [SPEAKER_01]: appointments for you.

[SPEAKER_01]: It's important to know the answers to these questions that you can feel comfortable going out of the hospital with your loved one and that the care will continue.

[SPEAKER_00]: Right.

[SPEAKER_00]: Make you sure that hand-off process is smooth.

[SPEAKER_00]: Exactly.

[SPEAKER_00]: I think one question that I always ask myself whenever I see post discharge situations is what's going to bring them back again?

[SPEAKER_00]: Yeah.

[SPEAKER_00]: What's the likelihood that a fall is going to happen again or another exacerbation?

[SPEAKER_00]: What's the most likely [SPEAKER_00]: situation that will bring them out to the hospital and it was a fall.

[SPEAKER_00]: Well, they better be working with physical therapy or they better be using their walk or at all times because these are critical elements that's going to put them at risk of another hospitalization.

[SPEAKER_00]: Exactly.

[SPEAKER_00]: Rehab and home health services.

[SPEAKER_00]: who needs it and how important is it?

[SPEAKER_01]: It's critically important for recovery.

[SPEAKER_01]: We have skilled occupational therapist and physical therapists in the hospital who do a focused assessment and typically make recommendations on whether they feel that someone is below their baseline level of functioning.

[SPEAKER_01]: And if they are, typically would recommend some sort of skilled therapy after the hospital stay, whether that is at a skilled rehab facility or whether that's at home with home health care therapies.

[SPEAKER_01]: It's important to follow those recommendations if it all possible because that's going to give you some supervised care in the outpatient setting that will enhance your recovery.

[SPEAKER_00]: And I just want to put an apply to say, PT is probably the most amazing service that we can offer people with any mobility or functional issue.

[SPEAKER_00]: But the key thing is that when you complete the program and you do great and you're back to your functional baseline, don't stop.

[SPEAKER_00]: Yes, whatever they teach you, whatever they program they taught you, whatever exercise that they taught you, keep doing it.

[SPEAKER_00]: Because if you stop, [SPEAKER_00]: You're going to regress to some degree.

[SPEAKER_00]: It should be part of your routine.

[SPEAKER_00]: Completely agree.

[SPEAKER_00]: Are there any other resources that are available for caregivers who need support during these transitional phases?

[SPEAKER_01]: The answer probably depends on where you live, but there are great community resources to support caregivers.

[SPEAKER_01]: One that comes to mind is area agencies on aging.

[SPEAKER_01]: These are typically phone numbers that you can call and basically ask any question that is on your mind.

[SPEAKER_01]: How do I get connected to X resource?

[SPEAKER_01]: And those folks are there to help you navigate, getting the resources that you need, whether that's connecting you to another community organization or knowing where to find a specific resource.

[SPEAKER_01]: Another resource that can be helpful is the social worker who is in your primary care provider's office.

[SPEAKER_01]: A lot of times these social workers are able to connect with community resources that can be helpful.

[SPEAKER_00]: Whenever I think about a safe and successful post-hospital recovery, I think of people who are able to regain their strength, their mobility, their vitality and independence after that stay.

[SPEAKER_00]: Can you share some success stories from your hospital practice about people who have done well?

[SPEAKER_01]: I think the folks that I've seen do the best in their recovery have been [SPEAKER_01]: optimistic about the recovery, but also patient with themselves.

[SPEAKER_01]: It can get very frustrating to know that you have a functional impairment that you didn't have before, but knowing that it's going to take time to build that backup is important and giving your body the patients to [SPEAKER_01]: Improve slowly is important because it's not going to be overnight, but keeping that positive attitude and keeping your goal in mind of what is most important to you.

[SPEAKER_01]: What are you looking forward to being able to do once you recover?

[SPEAKER_01]: I think that can really help us stay motivated through recovery.

[SPEAKER_00]: Well, we have a tradition here on the podcast, but we'd love to get to know you a little bit more.

[SPEAKER_00]: What does aging forward mean to you and how do you personally age well?

[SPEAKER_01]: Yeah, this is a great question for me to reflect on.

[SPEAKER_01]: In the midst of a busy career and recently having started a family, I have an eight month old at home.

[SPEAKER_01]: I often feel that I'm kind of on a treadmill.

[SPEAKER_01]: And so I've recently needed to tell myself to kind of take a pause and reflect and really enjoy the little moments in life because I love my career.

[SPEAKER_01]: I love the activities that I've involved in, but sometimes it just feels too busy.

[SPEAKER_01]: I think [SPEAKER_01]: The folks that I've encountered as a jury-trition who seem to have aged well always have that joy of life and so I try to find that every day.

[SPEAKER_00]: Just this morning, I was at the nursing home visiting with a ninety-nine year old who's [SPEAKER_00]: actually on hospice care and he looks great.

[SPEAKER_00]: He had a great attitude and before I left the room, he's like, Dr.

Chen, before he leave, I just want to say, I hope you find joy today.

[SPEAKER_00]: Oh, wow.

[SPEAKER_00]: And that almost made me tear up because I'm like, that is really sweet.

[SPEAKER_00]: He's like, that's why I'm ninety nine years old.

[SPEAKER_00]: I have found joy.

[SPEAKER_00]: Oh, that's wonderful.

[SPEAKER_00]: And then he decides to say, and some safety measures don't fall and don't drive into trees.

[SPEAKER_00]: Good advice.

[SPEAKER_00]: What's a question you'd like to ask our listeners today to really empower them to live their best?

[SPEAKER_01]: We talked a lot about risks of hospitalization and risks of [SPEAKER_01]: decline during a hospitalization today.

[SPEAKER_01]: So I think my question would be, what is one thing that you could do today this week, this month to reduce your risk of hospitalization, or if you were hospitalized to reduce your risk of poor outcomes?

[SPEAKER_01]: And I'm thinking about things like making an effort to improve physical function, maybe start a balanced training program to prevent falls, [SPEAKER_01]: making a appointment with your primary care provider to review your medication list or if you haven't already identify somebody who could be your alternate decision maker, if you weren't an emergency situation.

[SPEAKER_00]: Well, thank you so much for showing such a great message with us today.

[SPEAKER_00]: What I have found to be helpful about these conversations is learning more about the unknowns so that we're all better prepared to have a healthier mental guidance.

[SPEAKER_00]: So thanks for being part of that conversation.

[SPEAKER_00]: Thank you.

[SPEAKER_00]: It's my pleasure.

[SPEAKER_00]: So that's all for this episode.

[SPEAKER_00]: Hopefully you're feeling a little bit more informed, inspired, and empowered.

[SPEAKER_00]: On the next episode of Agent Ford, how nutritional needs change with age?

[SPEAKER_00]: So my father is eighty-six, almost eighty-seven, and over the past five years we always gave him just a hard time because he would always [SPEAKER_00]: extra soy sauce in his dishes.

[SPEAKER_00]: And we're like, well, dad, this already tastes pretty good.

[SPEAKER_00]: And then he'll have his own little pile, or he'll just pour on all his soy sauce.

[SPEAKER_00]: And luckily he doesn't have heart failure or anything.

[SPEAKER_00]: I have blood pressure, but now we're just like, you know what?

[SPEAKER_00]: This is how he likes his food.

[SPEAKER_00]: And he'll eat it better than he enjoys it better.

[SPEAKER_00]: If you have a topics suggestion for a future episode, you can leave us a voicemail at five zero seven five three eight six two seven two.

[SPEAKER_00]: And we might even feature your voice on the show.

[SPEAKER_00]: For more aging fort episodes and resources, head to mailclinic.org slash aging fort.

[SPEAKER_00]: And if you found this show helpful, please subscribe and make sure to rate and review us on your podcast app.

[SPEAKER_00]: It really helps others find our show.

[SPEAKER_00]: Thanks for listening and until next time, stay curious and stay active.