More older patients are stuck in hospitals
BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i2948 (Published 26 May 2016) Cite this as: BMJ 2016;353:i2948
All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
When my father was 88, he was hospitalized for dizziness, which occurred after his medication was increased. In the hospital, he was given more medication which made him confused, frightened, and incoherent. Then his doctor transferred him to a nursing home, where he was dirty, crying, begging people to hold his hand, and listed as DNR (Do Not Resuscitate) -- and given still more medication.
I convinced the doctor at the nursing home to discontinue all medication, and I hired a private nurse to give my father an organic diet, rich in fruits, vegetables, grains, beans, nuts, and seeds. In three days, my father made such a miraculous recovery, that the nurses on the ward didn't recognize him. When I called to speak to my father, he was back to his old self, and told me that he was bored and looking for a card game. My father was discharged the next day, and died several years later, while relaxing peacefully at home.
In retrospect, my father’s acute deterioration was caused by polypharmacy and poor diet. When these factors were reversed, my father’s health improved dramatically. I encourage my colleagues to pay more attention to the dangers of polypharmacy and poor diet, especially in the elderly.
Competing interests: No competing interests
Dear Sir, David Oliver's comments on the NAO report on delays in hospital discharge are well made. Sheer demographics enable us to predict that a large number of older people will need to be admitted to access appropriate treatment when they are ill, and their stay in hospital should be no more or less than is needed to deliver that treatment before they are enabled to leave hospital promptly. However there are a large number of older people with decompensated frailty who would be better managed from the outset outside hospital, who are highly likely to have hospital acquired complications and thus prolonged hospital stays. Currently despite lots of good work, we are simply unable to access intermediate care to support an alternative to hospital admission. It is to be hoped that this crisis does not just prompt a reflex response which shifts the, currently minimal, remaining community (health and social) care into expediting hospital discharge, at the cost of improving resource which can be used to avoid admission in the first place.
However, disgraceful though the situation is, this is not just a problem with underfunded social care. Where I live, for example, 75% of non emergency care packages are self funded but we are still unable to access care. There’s also a recruitment problem created by our national lack of respect for care as a worthwhile and well paid career and our expectation that the job of skilled and compassionate care can be delivered on pitiful wages with little or no training.
Competing interests: No competing interests
Re: More older patients are stuck in hospitals
As a student of the Faculty of Medicine of the University Foundation Navarra, and as a current user of health services I've experienced with my adult family elders, all the drawbacks, presented at administrative and operational level in several health centers, reason by which, this article presents an aggregate value of reflection on the responsibility that we as future doctor and social responsibility of the companies providing health and government. The article is called ( older patients are caught in hospitals) in this paper the same situation presented today in hospitals in Colombia for providing health services to the most vulnerable community is evident. Social inequality, lack of opportunity, lack of clear policies on public health to generate solutions to poor availability of resources that today are risk indicators for most of the hospitals in Colombia in search of improvement health services for elderly patients. It requires momentum emphasize programs that contribute to the care of these patients when they are discharged from hospitals, to contribute to the better quality of life.
Competing interests: No competing interests