Background:
Detection of geriatric syndromes is a critical step in caring for older patients and determining eligibility for post‐acute care services. Geriatric syndromes, notably delirium and malnutrition, are often undiagnosed and untreated in hospitalized elderly patients; and a history of falls, often overlooked, identifies patients at high risk for future preventable falls. We hypothesized that general internist physicians who specialize in acute hospital care (hospitalists) are more likely than nonhospitalist general internists to document diagnosis and assessment of these geriatric syndromes in hospitalized elderly patients who are subsequently transferred to post‐acute care services.
Methods:
We conducted a retrospective medical records review from a convenience sample of patients at least 70 years old admitted between March 1, 2006, and September 30, 2006, to the general medicine services of a large tertiary‐care teaching hospital who required post‐acute care services (skilled care, home care, rehabilitation). Patients admitted by hospitalists were matched for age, number of comorbidities, and admission diagnosis with patients admitted by nonhospitalists. For each patient, we examined the physician's written medical history, physical examination, diagnostic assessment, and plan to determine documentation of patient malnutrition, fall history, and delirium, using a structured protocol.
Results:
Of the 150 charts reviewed, 47 met inclusion criteria for this study. Patients of hospitalists and nonhospitalists were similar in mean age (81 vs. 78 years), length of stay (6.17 vs. 5.67 days), and number of comorbidities (12.29 vs. 14.17). Hospitalists diagnosed delirium more often in their elderly patients than did nonhospitalists (17% vs. 8.3%); but nonhospitalists documented an assessment for delirium slightly more often in their history, physical examination, or plan than did hospitalists (41.7% vs. 37%). Falls were recorded similarly by hospitalists and nonhospitalists (22.9% vs. 25%), although hospitalists were more likely to document characteristics of fall risk in their history, physical exam, or plan (68.6% vs. 50%). Hospitalists diagnosed malnutrition in 25.7% of patients compared with the 8.3% of patients that nonhospitalists diagnosed, but nutritional status was more often documented in the history, physical exam, or plan by nonhospitalists (75% vs. 62.9%).
Conclusions:
Geriatric syndromes are common in the hospitalized elderly who require post‐acute care services. Our study suggests that hospitalists are more likely than nonhospitalists to diagnose delirium, a history of falls, and malnutrition, although the data suggest both groups are evaluating their elderly patients for these syndromes.
Author Disclosure:
Amy Rybak, None; R. Palmer, None; F. Michota, None.