Background: The 2014 ACC/AHA Perioperative Guidelines suggest using the Revised Cardiac Risk Index (RCRI), myocardial infarction or cardiac arrest (MICA), or American College of Surgeons (ACS)-NSQIP calculators for combined patient-surgical risk assessment. Alrezk and colleagues recently published a new geriatric-sensitive cardiac risk index (GS-CRI) to predict MI or cardiac arrest in the geriatric population. We [...]

Background: Elderly inpatients often require the support of family and informal caregivers at transitions and yet adequacy of communication between hospital physicians and members of the patient’s social support is poorly studied. Methods: Mixed methodology survey of patients, their preferred social support member, and physicians as part of a communication quality improvement initiative on the [...]

Background: Family members often play a significant role in the care of geriatric patients during and after hospitalization. Both patients and families have expectations for communication with the provider team in the acute setting, but navigating the flow of medical information across the family unit is challenging with current care models. Pediatric medicine recognizes that [...]

Background: Our institution is a Level 1 regional trauma center with a large inpatient volume. A large percentage of these patients are elderly, with the traumatic events occurring as sequelae of their age, debility or medical complications. Last year, we developed a Trauma/Acute Care Surgery Hospitalist Co-Management program, due to, in large part, the increasing [...]

Background: According to the CDC, at least 300,000 people older than 65 are hospitalized for hip fractures annually. Society of Hospital Medicine recognizes geriatric care as one of the core competencies, and hospitalists frequently provide care to geriatric hip fracture patients. Clearly hospitalists need to be competent providing care to such patients. Our goal was [...]

Background: Despite its prevalence, constipation is frequently under-recognized and treated with ineffective agents in hospitalized older adults. Methods: An anonymous survey was distributed to physicians regarding constipation management in hospitalized older adults. Chi-square or Fisher’s exact, as appropriate, were used to explore associations between demographics and survey answers. T-test was used to compare groups on [...]

Background: The number of individuals with dementia in the U.S., currently estimated at 5.3 million, is projected to triple by 2050. For patients with cognitive impairment, the unfamiliar and stressful hospital environment often requires constant observation (CO) to ensure patient safety. The use of constant observation (CO) in the hospital setting, while originating in patients [...]

Background: Medicare patients account for over 50% of hospital days at a cost of over $1 trillion per year. Yet, hospitalization of older adults often results in poor outcomes. Furthermore, the number of geriatric healthcare providers dedicated to the care of hospitalized vulnerable older adults is currently insufficient. Purpose: Our objective was to create an [...]

Background: Transient elevations of blood pressure are common in hospitalized older adults and may lead inpatient clinicians to intensify inpatient antihypertensive therapy and discharge patients on these intensified regimens. Intensification of outpatient regimens during hospitalization can easily become over-treatment once patients return home, increasing patients’ risk of adverse drug events including syncope and falls. Thus, [...]

Background: Venous thromboembolism (VTE) is a major cause of morbidity and mortality in the United States. The increased risk of VTE among medically ill older adults is firmly established. Guidelines strongly promote the use of pharmacologic VTE prophylaxis in this population, yet studies have suggested sub-optimal prophylaxis rates. Our study aimed to describe current provider [...]