Emerging Challenges in Acute Care for Older Adults

Abstract

The population of older adults (aged 65 years and above) in the United States, as a proportion of the population, is increasing. Between 1900 and 2010, a 300 percent increase in the proportion of this group was recorded. The disproportionate growth in this segment of the population comes with an unprecedented impact on the US health care system, mostly because the older adults consume a larger share of American health care services. This dissertation explores the trend in hospitalizations for traumatic brain injury for this population over a 12-year period, the likelihood that an older adult admitted to the hospital will acquire Clostridium difficile before discharge, the role of hospital in hospital acquired Clostridium difficile infection, and the impact of Medicare Part D on preventable hospitalization.

Our results indicate that traumatic brain injury hospitalizations occur at a disproportionate rate – approximately 58 times more hospitalizations per 10,000 populations for older adults. In addition, the rate at which older adults are hospitalized for TBI increased at a significantly higher rate – most especially patients within the age group of 75 to 84 years – than any other age group over the study period. Approximately 55 percent of all cases of TBI hospital discharges are fall related. The results also show that 60 percent of all hospital discharges with a diagnosis of hospital acquired C. difficile infection occurred in those above 65 years, surgical procedure did not affect whether or not a patient acquired C. difficile infection in hospital, and that the driving factors of hospital acquired C. difficile may be more attributable to individual characteristics than hospital characteristics. Finally, the results also show that that the implementation of Medicare Part D in 2006 was associated with an increased uptake in older adults who had coverage for outpatients drug prescription, and that the increase in coverage reduced potentially preventable hospitalization by 40 percent for medication sensitive condition but no significant change in non-medication sensitive hospitalization.