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Hospital management of older adults

Melissa Mattison, MD, SFHM
Section Editors
Kenneth E Schmader, MD
Andrew D Auerbach, MD, MPH
Deputy Editor
Daniel J Sullivan, MD, MPH


In 2008, patients 65 years and older represented 40 percent of hospitalized adults and nearly half of all health care dollars spent on hospitalization, but comprised less than 13 percent of the population in the United States [1]. Individuals 85 years and older make up only 1.8 percent of the total population but account for 8 percent of all hospital discharges [2]. Hospitalizations and health care spending for older adults are expected to rise as the population continues to age.

The leading diagnoses for admission among community-dwelling adults ≥65 years are cardiovascular diseases (28.6 percent) and infections (16.2 percent), with pneumonia and septicemia being the two most common infectious causes [3]. Older patients have a longer average length of stay compared with younger patients (5.5 days for ages ≥65 years, 5.0 days for ages 45 to 64 years, and 3.7 days for ages 15 to 44 years) [4]. With advancing age, patients tend to have more comorbid chronic illnesses and disability, making them more vulnerable during hospitalization to adverse events, including nosocomial complications and adverse drug reactions [5]. While most younger patients are discharged to home, 40 percent of patients 85 years and older are discharged to a skilled nursing facility (SNF) [2].

Most hospital-based clinicians are not trained to treat older adult patients [6]. Despite the disproportionate prevalence of hospitalized patients who are in the older age range, hospitalist programs often do not emphasize the need for geriatric skills [7].

This topic will discuss common issues related to the management of older hospitalized patients. The medical care of older adults in the outpatient setting and in nursing homes is discussed in detail separately. (See "Geriatric health maintenance" and "Medical care in skilled nursing facilities (SNFs) in the United States".)


Older adults have greater vulnerability to acute stress than younger individuals due to age-related diminution of physiologic reserves. This vulnerability is compounded by the greater prevalence of chronic disease (eg, hypertension, chronic kidney disease, and heart failure) in older adults. Measuring physiologic vulnerability in older adults can be challenging. Diminished renal function can be detected with serum creatinine, but quantifying the decline in organ function in other systems, such as the liver, heart, lungs, and brain, is more challenging. Often, vulnerability only becomes evident in hindsight after organ failure. Muscle strength and reserve also decline with aging, with detrimental impact on physical function. (See "Normal aging", section on 'Age-associated physiologic changes'.)

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Literature review current through: Nov 2017. | This topic last updated: Oct 16, 2017.
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