Quality Indicators for Hospitalization and Surgery in Vulnerable Elders

Published in: Journal of the American Geriatrics Society, v. 55, no. S2, Oct. 2007, p. S347-S358

Posted on RAND.org on December 31, 2006

by Vineet M. Arora, Marcia L. McGory, Constance Fung

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Hospitalization presents unique challenges in older people. Older patients may be more likely to suffer from comorbid illness or have diminished physiological reserves that impair their ability to maintain homeostasis in the context of acute illness. A variety of geriatric syndromes, such as dementia, delirium, and gait disturbance, are more common in older patients admitted to the hospital than in younger patients. In addition, vulnerable elders (VEs) may develop nosocomial or hospital-acquired pneumonia as an iatrogenic complication of hospitalization. Likewise, the risks of complications after surgery are also generally greater for elderly patients, primarily because of the frequency and severity of comorbid illnesses. In this article, quality indicators (QIs) for the general medical care of hospitalized VEs are presented, with a focus on elderly patients with pneumonia and those undergoing major surgery. For each indicator, the available supporting data are reviewed. METHODS: A total of 485 articles were considered in this review: 24 identified through a Web search, 84 through reference mining, 369 through the Assessing Care of Vulnerable Elders (ACOVE)-3 literature searches, and two through reference mining the ACOVE-1 monograph. Five additional articles were included after peer review. RESULTS: Of the 35 potential QIs, the expert panel process judged 30 to be valid (see the QIs on pages S464-S487 of this supplement), and five indicators were rejected. The literature summaries that support each of the indicators judged to be valid in the expert panel process are described.

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