Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Pause Before Hospitalizing the Elderly


Confusion among hospitalized older adults is common and dangerous. The hospital environment should be avoided if at all possible, with a goal of managing acutely ill older adults at home.

When older adults get sick, it’s important to understand what’s wrong, how they want to be helped, and what the options are for meeting their needs.


Sometimes the most familiar path—hospitalization—is not the best path. Hospitals are often noisy, disruptive environments that contribute to acute confusion. Even a trip to the emergency department may be exhausting and dangerous.


So, except for when someone is blue or unconscious, it usually pays to stop and ask—is the hospital the best place for my patient and are there alternatives?


As the author of, “Pause before hospitalizing the elderly, Stanford researchers say,” notes, delirium is common in hospitalized older adults (30 – 50% on medical units) and may cause permanent impairment of cognitive function.


When hospitalization is the best option, there are programs and environments that can reduce the risk of confusion, and improve maintenance or recovery of function.


However, with current diagnostic and therapeutic technologies, it’s now possible to treat patients at home for conditions such as pneumonia, cellulitis, exacerbations of chronic obstructive lung disease, or heart failure with better patient outcomes and satisfaction than treatment provided in the hospital.


Our patients need the best care; home based care is sometimes the best choice. It also means that we need to be teaching all who deliver healthcare, direct health care, or build systems of care, that this is the present and future.