Structural, process, and clinical factors associated with hospital-acquired conditions in older adults: A retrospective study

PURPOSE: This study aimed to describe hospital-acquired conditions in older patients hospitalized in an acute care hospital and to examine their associations with clinical patient-related and organizational factors. METHODS: A secondary analysis of data collected in the electronic health records of a Swiss teaching hospital. The study included 5813 older adults hospitalized in 2019 across 21 medical and surgical units. RESULTS: Hospital-acquired conditions were observed with notable prevalence rates for delirium (3.1%), falls (3.6%), pressure ulcers (5.2%), and weight loss (8.8%). Despite the availability of geriatric assessment scales, their use was inconsistent and limited, with assessment rates for most scales ranging from 1.8% to 28.2%. Only the scales for falls risk (Stratify, 51.0%) and pressure ulcer risk (Braden, 94.8%) were documented routinely. Multivariable analysis revealed that, beyond age and length of stay, the use of benzodiazepines (OR=1.76) and antipsychotics (OR=2.05) during hospitalization were significantly associated with an increased risk of falls. Furthermore, few care units had implemented patient-centered approaches tailored to older adults. CONCLUSION: Hospital-acquired conditions in older patients remain a major concern in acute care settings. Our findings highlight a significant disconnect between the availability of geriatric assessment tools and their clinical application. This pattern suggests that assessment practices may be driven more by institutional requirements than by patient-centered clinical needs, underscoring the urgent need to improve the implementation and culture of geriatric-focused care.