Examqo › Examqo library › Geriatric medicine › Assessment, pharmacology and hospital care · IMLE
Hospital care of older adults
Hospitalisation is dangerous for an older adult even when the illness itself has been treated: bed rest, fasting, catheters, sedatives and disrupted sleep cause delirium, falls, pressure injuries and functional decline — so mobilise early, remove catheters, prevent delirium and plan discharge from day one.
Why it matters in the exam
The exam presents an older adult who was independent, was admitted with pneumonia and left unable to walk — and asks what would have prevented this: early mobilisation, avoiding urinary catheters and restraints, nutrition, avoiding sedatives, and a geriatric unit or team. About a third of hospitalised older adults are discharged with a new decline in activities of daily living.
Recurring points: ACE units (acute care for elders) reduce functional decline and discharge to institutions; the HELP programme (volunteers and staff providing orientation, sleep, mobility, nutrition, glasses and hearing aids) reduces delirium and falls; an indwelling urinary catheter increases infections and falls and is kept only when indicated; and at discharge — medication reconciliation, a clear letter and an early follow-up visit reduce readmissions.
The exam also asks about the "post-hospital syndrome": in the month after discharge the older adult is weak, confused and sleeps poorly, and is at high risk of falling and readmission. So continuity is planned in advance — physiotherapy at home, help with medications and meals, and a clear explanation to the patient and family about warning signs.
Prolonged fasting before tests, unnecessary intravenous fluids and lack of daylight and activity also contribute to confusion and weakness, so they should be kept to a minimum.
Key points
- About a third of hospitalised older adults are discharged with new functional decline.
- Early mobilisation, nutrition, sleep, glasses and hearing aids.
- Urinary catheter and restraints — only when indicated; avoid sedatives.
- ACE units and the HELP programme reduce functional decline and delirium.
- Discharge: medication reconciliation, a clear letter, follow-up within 7–14 days.
Summary table
| Hospital hazard | What causes it | Prevention |
|---|---|---|
| Functional decline | Bed rest, "not allowed to get up", immobility | Mobilisation from day one, physiotherapy, sitting up for meals |
| Delirium | Drugs, sleep deprivation, missing glasses and hearing aids, catheters | Multicomponent prevention programme (such as HELP) |
| Falls and pressure injuries | Weakness, confusion, catheters, unsuitable surface | Supervised mobility, repositioning, a suitable mattress |
| Catheter-associated infection | A catheter "for convenience" | Catheter only when indicated; remove early |
| Undernutrition | Fasting for tests, unsuitable food, difficulty eating alone | Avoid unnecessary fasting, help with eating |
| Transitions between settings | Medication discrepancies, missing information | Medication reconciliation, a clear letter, follow-up within 7–14 days |
In the full version for subscribers
- A simple algorithm
- Memory aid
- Exam traps
- 5 review cards
- Enough for IMLE
The full version is open to subscribers of: Geriatrics, Medical licensing exam (IMLE), Internal medicine, Family medicine, General surgery.
Subscriber? Read the full topic Plans and prices 25 free questions
Sources
- Hospital Elder Life Program (HELP) — evidence summaries and meta-analysis, 2015–2018 — Delirium and fall prevention in hospital
- Acute Care for Elders (ACE) units — meta-analysis, 2012 — Functional decline, length of stay and discharge to institutions
- Geriatrics Review Syllabus (American Geriatrics Society), 11th edition (2022) — Hospital care and transitions of care
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.