How to Support an Older Adult in the Hospital

Understanding Hospital Dynamics

Most of us find ourselves in the hospital at one point or another. For those less familiar with a hospital setting, understanding the dynamics can feel overwhelming: Who are all of the doctors and nurses coming in and out of the room? And who should you go to when you need help?

While all hospital systems are structured differently, the guide below breaks down some of the staff that will likely be involved in your care and what each of their roles are. We’ve also included tips for those supporting a loved one during a hospital stay.

Your Attending Physician Is at the Center of Your Care

Since most of us don’t spend a lot of time in the hospital, understanding how decisions within this setting are made can be confusing. As such, it’s particularly important to understand the role of your attending physician.

This doctor plays the most significant role in your care. They’re called the “attending” physician because they are literally attending to you and your care. In fact, their name appears above yours on every page of the medical record. Only your attending physician (or someone they delegate, like a resident or another doctor covering over the weekend) can write orders regarding your care, be it something as simple as your diet or as complex as chemotherapy. When you’re admitted, the attending physician writes admitting orders, and only they (or a designee) can write a discharge order.

Some additional things to understand about attending physicians include:

• Attending physicians are only granted admitting privileges to hospitals where they are affiliated. 
• They typically can only admit patients based on their area of practice — i.e. a pediatrician will deal with the care of children, or an orthopedist will deal with the care of a joint-related issue.
• When a patient requires specialized care for something an attending physician may not be an expert in, a consulting physician may be called in to deal with a particular problem, such as a dermatologist for a rash on a patient. These physicians do not assume ultimate responsibility for the care of the patient; that’s still the attending physician. All the consulting doctors you’ll see are determined by your attending physician, and they are free to take or reject the advice given.
• When you get admitted to a hospital, where you physically end up within the facility depends largely on who your attending physician is, and accordingly, what hospital service they admit to. For example, if you come to the ER with appendicitis, you’ll be admitted to a surgical service and your attending physician will be a surgeon. If a heart issue brings you in, you’re likely to end up in a cardiac unit with a cardiologist as your attending physician.

Your Attending Physician Is Unlikely to Be Your Primary Care Physician

It used to be that the doctor who cares for you in the office would also be the doctor that cares for you in the hospital. Now, this is generally not the case, though there are some exceptions (such as concierge physicians or underserved communities where there are simply not enough physicians). These days, most medical care in the hospital is provided by a hospitalist. Hospitalists are attending physicians (usually internal medicine physicians) who take care of patients in the hospital full-time. When you are on a hospitalist service, your primary care physician relegates your hospital care to this physician while you’re there.

Other Critical Staff in Your Hospitalization

While your attending physician is at the center of your care, they’re working hand-in-hand with a team of exceptional nurses, assistants, and more. Here are some of the other hospital staff that will be critical to your stay:

• Nurses: Nurses provide minute-to-minute support, following physician orders, taking vital signs, and assessing new symptoms. They educate you about your condition, interact with your family and friends, and innovatively troubleshoot a whole range of medical and non-medical problems. In most hospitals, you’ll be assigned a primary nurse who has responsibility for your care. While they’re not there 24/7, they’ll be responsible for most of your assessments and describing your condition to the next nurse coming on shift. In short, they are the nursing equivalent of an attending physician. 
• Certified Nursing Assistants: Certified Nursing Assistants (CNAs) provide critical assistance to the nursing staff. They go by a variety of names; a few of the most common alternatives are patient care technicians and patient care assistants. They often provide direct services such as bathing, walking you to the bathroom, taking your blood pressure, and more so that your nurse can tend to some of the more technical aspects of your care (like mixing medications or starting an IV).
• …and more: Depending on why you’re hospitalized, you may meet nutritionists, physical therapists, occupational therapists, speech therapists, social workers — and the list goes on. Additionally, many of these providers also have a supporting team assisting them in your care (like a physical therapy technician). You should never feel uncomfortable asking who someone is and why they are there to see you. It can also help to write down someone’s name and role as soon as you meet them so that you can familiarize yourself with the full team. These days, many hospitals keep a whiteboard on the wall identifying all members of the “supporting cast” by name and roles.

How Loved Ones Can HELP During a Hospital Stay

During a hospital stay, we rely on physicians, nurses, and other staff for everything big and small, from our meals to our moment-to-moment care. But their roles shouldn’t cause us to underestimate the importance of our loved ones, whose presence and support is also critical to the experience.

Research has shown that loved ones play an enormous role in a patient’s wellness during and after a hospital stay. A program called HELP — The Hospital Elder Life Program — has been used successfully for over 25 years to prevent things like functional decline and delirium (confusion) in the hospital. We’ve included some tips from it below.

• Stay with the patient as much as possible: Daily visitors who provide structured activities to keep patients engaged and socially interactive are hugely important. Assistance and companionship is particularly helpful during meals.
• Bring the complete medication list to the hospital: Bring the patient’s Medical 101 Sheet to the hospital with the names and contact information for primary doctors plus all the medications being taken. Medications should be reconciled upon admission and discharge. 
• Make it feel like home: It can also be helpful to bring in a few familiar objects from home, like family photos, a favorite comforter or blanket for the bed, or a beloved book.
• Help orient the patient throughout the day: Speak in a calm, reassuring tone of voice and tell the patient where they are and why they are there. It’s helpful to do specific reorienting activities so that patients know what day it is, what time it is, who is taking care of them, and what the day is going to be like with regards to tests and physician visits. When giving instructions, state one fact or simple task at a time; be careful not to overwhelm or overstimulate the patient.
• Early mobilization: Safely help patients walk as soon as possible, after the go ahead (and with assistance) from the medical team.
• Non-drug approaches to restoring sleep: If the patient is having trouble sleeping, milk or herbal tea, soothing music, and massage may be more helpful than a sleeping pill to promote normal sleep patterns while minimizing medications. Disordered sleep is the primary cause of delirium.
• Adaptive hearing and vision devices: If the patient typically wears glasses or uses a hearing aid, make sure to bring them to the hospital so that the patient can hear and see to the best of their ability. The same goes for dentures — patients may not be able to eat without them.

If you detect signs that could indicate delirium — confusion, memory problems, personality changes — it’s important to alert nurses or physicians as soon as you can. Family members are often the first to notice subtle changes.