"You can dress yourself, walk down the hall and climb half a flight of stairs -- you don't need rehab": Ageism in health care and rehab

Background: A 67-year old retired chemistry professor was admitted to hospital in 2006 with pneumonia (wcc=50,000) and a pleural effusion. Apart from a daily multi-vitamin, he took no prescription or over-the-counter drugs. Prior illnesses were two pneumonias and pleural effusions in 2003. Objectives: To identify barriers to quality care for older adults and suggest alternatives that would improve care and outcomes. Methods: The patient's wife became the case manager. She arrived for morning rounds, stayed up to 14 hours and took extensive notes over a three-week period. Results: In the first 24 hours, the patient was moved to four rooms on three floors and transported for procedures. He was sedated three times (chest tube, broncoscopy and, after being placed in soft restraints, to calm him). Statements that he was claustrophobic were ignored. Notes indicated that the patient might be “sundowning” or suffering alcohol withdrawal. His bed was placed so that he saw only a blank wall. After a 30-lb weight loss and more than two weeks in hospital, including three hours of cardiothoracic surgery, approval for inpatient rehab was nearly withdrawn because a young therapist thought it unnecessary (see title). Discussion: Until his wife arrived, the patient was regarded as possibly senile or alcoholic, rather than as a very sick man, the cause of whose pneumonia needed to be identified (mycobacterium avium intracellulare had been cultured in 2003 but not followed up). Although lack of coordination among eight services was a factor, ageism was a bigger barrier to full recovery.