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Hospitalization rates increase significantly as the population in the US continues to age. Older patients tend to have more chronic conditions, frailty, and less independence in their daily lives.

And that has great implications for hospitals, both for admissions and the risk for readmission.

“Their admissions have a higher level of complexity which leads to a longer length of stay, increased cost, and increased demand on staff,” said Ethan Molitch-Hou, MD, a UChicago Medicine hospitalist and chair of the section’s wellness committee in Chicago. “Additionally, they have a higher probability they won’t discharge back to their home and higher rates of readmission.”

The factors that lead to readmission vary but often include falls and polypharmacy, he said. Prevention of these admissions is possible theoretically but in reality can be exceedingly challenging without comprehensive geriatric assessments and an increase in community-based care, Molitch-Hou said.

Clinical Factors for an Aging Population and Hospitalists

As the population of US adults increases, there are health implications that affect the care model.

“Many elderly patients have hearing, vision, or cognitive impairments that can impair effective communication, especially with caregivers often having additional obligations,” he said.

Multidisciplinary collaboration from nursing, pharmacy, social work, and physical and occupational therapy is needed to optimize discharge planning and postacute care transitions, Molitch-Hou said.

Delirium is one standout concern in hospital medicine. With regard to older patients, they’re at heightened risk for delirium, requiring regular reorientation, minimization of unnecessary medications, and avoiding medications prone to causing delirium, he said. Changes to the environment and system are required to ensure medication schedules do not interfere with sleep.

“Avoiding midnight vitals when able to allow uninterrupted sleep. Reducing additional external devices like telemetry or foley catheters whenever able,” he said.

Early discussion of care goals, including advanced directives and family input, ensures treatment aligns with patient values. Hopefully this is done with their primary care doctor, but often the sentinel event in the hospital is the first time that prompts these discussions, Molitch-Hou said.

Hospital Medicine Burnout and Aging Adults: Key Points

Burnout among hospitalists and other physicians is a complex issue with multiple contributing factors. Both individual and organizational elements are involved. Although excessive workload is a significant factor, additional contributors include irregular shift schedules, suboptimal system design, and heightened patient complexity, said Molitch-Hou.

“Workload includes the overall cognitive load that a patient can entail. In the sense of our aging population, the extra effort it takes to provide proper care for our older patients who often take more than 10 medications and have multiple comorbidities will take a higher cognitive load than the simple patient who only has a simple cellulitis,” he said.

Additionally, this group faces the emotional difficulty of frequent end-of-life conversations.

“There can be ethical dilemmas and moral hazard that comes with providing care that at times can feel futile or harmful at the end of life when the goals of families don’t align with a patient who cannot make decisions,” Molitch-Hou said.

Hospitalists Are Essential for Patient Care

Hospitalists must coordinate closely with case managers, therapists, social workers, and families, making discharge a major part of clinical care rather than an administrative afterthought, said S. Hasan Naqvi, MD, MBA, professor, chief medical officer-inpatient, and medical director, Clinical & Translational Science Unit at the School of Medicine, University of Missouri, Columbia, Missouri.

And family communication is more frequent and more consequential in the care of older adults. “Family members are often deeply involved because of cognitive decline, functional dependence, or serious illness. Hospitalists spend substantial time updating families, aligning expectations, and mediating disagreement, which is essential work but often invisible in productivity metrics,” he said.

Also, he noted how emotional labor is higher.

“Caring for older adults often means repeated exposure to suffering, grief, uncertainty, and morally difficult choices,” Naqvi said. “This makes hospital medicine more than a high-volume specialty; it is also one with a significant emotional burden that contributes directly to burnout.”

Additionally, burnout worsens when physicians feel they are providing care that is misaligned with a patient’s goals, unlikely to help, or unnecessarily prolonging suffering, he said.

When it comes to reducing burnout, Naqvi said a return to basics is needed.

“That requires better staffing, stronger interdisciplinary support, and more training in palliative care, serious illness communication, and the emotional realities of inpatient care,” he said. “If we want hospitalists to thrive, we need to create a system that preserves autonomy, supports teamwork, and recognizes the full complexity of caring for an aging, medically fragile population.”

No reported disclosures.