Not All Hospitals Treat Seniors the Same

Author: St. Michael's Hospital
Published: 2011/06/06 - Updated: 2025/02/19
Publication Type: Research, Study, Analysis
Category Topic: Rehabilitation and Hospitals - Academic Publications

Page Content: Synopsis - Introduction - Main - Insights, Updates

Synopsis: This report highlights a study revealing that hospitals delivering high-quality care to younger patients do not necessarily provide the same standard of care for the elderly. The research, published in the Journal of the American College of Surgeons, evaluated elderly patients 30 days post-emergency surgery and found a significantly higher risk of serious complications and mortality compared to younger patients. Notably, hospitals excelling in young patient care did not always achieve similar outcomes for older adults, suggesting the need for tailored strategies to address the distinct needs of the elderly. The study emphasizes the importance of developing specific quality measures and programs, such as increased collaboration with geriatricians, to enhance care for this vulnerable population. Implementing such measures can lead to more efficient care, reduced delirium, and a higher likelihood of elderly patients returning home rather than transitioning to long-term care facilities - Disabled World (DW).

Introduction

Hospitals that provide quality care for young people do not always provide the same quality care for the elderly, a new study has found.

Main Content

As our population ages and requires more healthcare, hospitals need to measure the quality of care they provide for the over 65s and implement programs to meet their distinct needs, said the study's author, Dr. Avery Nathens, trauma director at St. Michael's Hospital.

The study, published in the June issue of the Journal of the American College of Surgeons, evaluated the condition of elderly patients 30 days after they underwent emergency surgery. Not surprisingly, it found these patients had a significantly higher risk of serious morbidity and mortality compared to younger patients.

What was surprising was that centers that provided high quality care for the young did not necessarily do so for the elderly.

"This suggests that some hospitals put into place something unique that better addresses the needs of elderly patients," said Dr. Nathens. "What's put into place, however, is not quite clear."

Previous studies have shown that steps can be taken to improve patient outcomes for elderly people undergoing elective surgery, such as consultation and pre-surgical testing to reduce the risk of heart attacks and strokes, aggressive medical management and, in the United States, referrals to clinics that perform high volumes of the most complex procedures.

These options are not available to elderly patients who require emergency surgery, so hospitals must find other ways of providing them with quality care, Dr. Nathens said.

He said the study speaks to the importance of developing measures that specifically focus on the quality of care delivered to older patients. This study and others have shown that, this is probably one of the only ways we can be certain that the elderly are receiving the care they need.

"Much like we report on hospital performance in other areas, we need to provide assurance that hospitals are providing high quality care to some of their highest risk patients," said Dr Nathens. This would provide hospitals with the information they need to develop strategies to provide better care to these patients.

When it comes to emergency surgical patients, one strategy could be more collaboration with geriatricians.

In St. Michael's Trauma Program, a geriatrician sees every patient over 60 who experiences a major injury and makes recommendations regarding their care and treatment. This program - the first of its kind in Canada - has shown significant benefits, with fewer consultation requests to internal medicine and psychiatry, meaning more efficient care, and a reduction in delirium, which can be common among elderly hospital patients, costly, preventable, and associated with higher morbidity and mortality. Most importantly, fewer elderly patients are being discharged from the hospital to long-term care facilities than before the partnership with geriatrics began in 2007.

In addition, all patients over 65 are given a risk of fall assessment and a frailty assessment before being sent home.

"This work highlights the need for enhancing quality of care for older people and the need for more geriatricians," said Dr. Camilla Wong, a geriatrician in St. Michael's Geriatric Trauma Consultation Service.

"We don't have very many in Canada - fewer than 0.5 for every 10,000 people over age 65. Compared with the U.S., the U.K. and Europe, we have a significant shortage of geriatricians, especially considering the increasing proportion of older people in Canada"

St. Michael's Hospital

St. Michael's Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 23 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, and care of the homeless are among the Hospital's recognized areas of expertise. Through the Keenan Research Center and the Li Ka Shing International Healthcare Education Center, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

Insights, Analysis, and Developments

The findings presented in this report underscore an urgent and often overlooked issue in modern healthcare: the assumption that what works for younger patients will automatically translate to positive outcomes for the elderly. As medical science advances, hospitals must ensure that quality care does not have an age bias. Addressing the unique challenges faced by older patients - such as frailty, medication interactions, and post-surgical cognitive decline - requires deliberate policy changes and specialized treatment approaches. The medical community should view this study as a call to action, not just for geriatric specialists but for all healthcare providers, to rethink how care is structured for an aging population

Attribution/Source(s): This quality-reviewed publication was selected for publishing by the editors of Disabled World (DW) due to its relevance to the disability community. Originally authored by St. Michael's Hospital and published on 2011/06/06, this content may have been edited for style, clarity, or brevity.