Quality Indicators for Hospitalization and Surgery in Vulnerable Elders

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.