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Why aren’t hospitals designed with older patients in mind?

Written by Diane Archer

Last Saturday, I was with my mother-in-law at the rehab facility to which she had been sent for physical therapy the previous evening, post hospital discharge, to regain the strength she needed to use her walker. She was lying in bed, told not to walk on her own, and expected to wait until Monday for the physical therapy she needed. Like this rehab facility, hospitals are poorly designed for older patients, reports Dr. Louise Aronson, a geriatrician, in StatNews. Why aren’t hospitals and rehab facilities designed and operating with their older patients in mind?

The US should do more to equip hospitals in ways that optimize care for older adults. Older adults represent almost 40 percent of people in hospitals. Dr. Aronson’s thesis is that if hospitals were designed to better care for older adults, it would promote the greater good of hospital inpatients of all ages and their families.

But, strangely, hospitals tend not to consider the needs of older patients in their design. Corridors tend not to have handrails or seating to allow people to rest. Much like most dinner menus at restaurants, signs tend to be hard to read. Simple evidence-based fixes would go a long way to providing older adults and others better care.

For example, at the University Hospitals of Cleveland, the Acute Care for Elders program has hospital wards for older patients designed to get them out of hospital faster and with fewer complications. Of note, not only is the program better for older patients, it shortens their hospital stays and costs less. The Hospital Elder Life Program (HELP) helps to prevent delirium in older patients.  And geriatric emergency departments work to get older patients safely back home post emergency instead of admitting them to hospital.  

Age-Friendly Health Systems should be our goal for older adults. They are designed to ensure older adults get the best care possible and to avoid health care-related harms. Their objective is for older patients to be satisfied with their care. For example, they might have staff call buttons that are voice-activated so they are easier to use.  They might have an extra bed for a family member to stay with the older patient.

I was stunned that my mother-in-law, who needed more than anything else to get moving after her hospital stay, was forced to lie in bed for two days at the best-in-class rehab facility in her town, with her muscles further atrophying, because no physical therapists were on duty over the weekend. Dr. Aronson observes similar unnecessary challenges for older patients in hospital. Is this about the facilities saving money? It is certainly not about meeting the needs of patients. What will it take for this to change?

Here’s more from Just Care:



  • Not only are hospitals not designed for older patients, they’re difficult for older visitors. I recently needed to make multiple visits to a patient in ICU. The trek from the parking lot was more tiring than the actual visit. Long halls that curved so it was difficult to stay oriented, signage was inadequate so I had to keep finding someone to ask if I was headed in the right direction, no signs in the parking lots to point to the closest entrance, and no places to get healthy food.

  • I liked your article , as it represents advocacy for older patients. I volunteer at a nursing facility in Saratoga, NY. The workers seem dedicated, but your argument seems more pointed toward the administrators who design policy, yes?

  • Thanks for pointing out some important facts. Much in agreement with Diane! Thousands of people are feeling the same way which you have experienced during the hospital visit with your mother-in-law. Even though senior population forms a huge customer base, everything in the healthcare industry seems focusing only on elder adults and children. Many of the hospitals in US are said not to have even hand rails or chairs with arm rest. Elderly are required to have long walks down the halls in order to get their complicated paperwork done or to get their radiographs done. Think how difficult it is for them?

    But some hospitals are nowadays using digital solutions which assist the elderly to get their check up and associated stuffs done from their home itself via technology support. Doctors can check their patients/ analyze the health parameters captured using gadgets worn by elderly and diagnose health conditions, suggest appropriate medications and routines to be followed by the patient. Patients can be made enrolled in a healthcare plan which necessarily consists of exercises, dietary instructions, medication support etc. It will help to keep the elderly maintain their health by making them engaged in a good manner. Even systems to track their progress in completing the plan also exists. Even though Medicare won’t sponsor for wearable gadgets, there are patients who got those devices for free through other government programs like “Pilot Project”. I can refer you some digital healthcare systems which contains some special use cases of applications designed for elderly care ( see the attachment above ). These technological innovations can tremendously reduce unnecessary hospitalization of the elderly and thus provides them room for more comfortable stays at their homes itself.

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