Shingles — prevention, treatment, and the pain that lingers

Reviewed by the How To Help Your Elders Medical Advisory Process

Hospitals save lives, but they also create new problems for older patients. Delirium, falls, infections, muscle loss, and medication errors are common during hospitalization of adults over 65. Your presence, your advocacy, and your preparation for discharge can meaningfully reduce these risks and protect your parent from coming home weaker than they went in.

Hospitals Create Specific, Preventable Risks for Older Adults

You got a call at work. Your mother fell. It was bad enough that she went to the emergency room, and they want to admit her to the hospital. Your first feeling is relief. She's going to get care. She's going to be monitored. She's going to be safe in a place where there are doctors and nurses and equipment. You take it for granted that hospital is better than home in a crisis. Most of the time it is. But there's a side of hospitalization that nobody warns you about ahead of time, a reality that becomes visible around day three or four when you realize that the hospital itself is creating new problems as it tries to solve the original one.

Your father spent two nights in the hospital after a procedure that went fine. When he came home, he was weaker than he was going in. He couldn't walk as far. He seemed confused about things he had understood before. You asked the hospital why this happened and basically got a shrug. They said it happens. You asked if there was something they did wrong and the answer was not quite no. It was more like: your father is elderly, hospitals are disorienting, sometimes people decompensate.

This is the paradox that nobody talks about clearly. Hospitals save lives. Hospitals also, in the case of elderly patients especially, create new medical crises in the process. The Agency for Healthcare Research and Quality (AHRQ) reports that adults 65 and older account for approximately 35% of all hospital stays but experience a disproportionate share of adverse events. The CDC reports that approximately 1 in 31 hospital patients has at least one healthcare-associated infection on any given day. A study published in the New England Journal of Medicine found that approximately one-third of adults 70 and older experience functional decline during hospitalization, meaning they leave the hospital less able to care for themselves than when they arrived.

The reality is more honest and more actionable than what hospitals typically communicate: there are specific risks that older people face, and there are specific things you can do to reduce them.

The Paradox

The hospital is full of equipment and people trained to use it. When your parent needs urgent care, they need it badly. The hospital is lifesaving.

But hospitals are also strange, disorienting environments designed for efficiency rather than for the comfort and safety of confused older people. There are alarms going off. The lighting is artificial and often dim. The noise level is higher than a home. Multiple people come in and out. Shift changes happen and nobody tells your parent. Medications are given but the schedule is different from home. The bed is uncomfortable. Nobody has asked about habits or preferences. Sleep is interrupted. They don't know where the bathroom is. They don't know what time it is.

Hospitals are built for younger people who can tolerate noise, disruption, and discomfort. For an older person, the same disruption that's mildly annoying to a 40-year-old is actually a serious stressor that accelerates decline.

The Risks

Several specific things tend to happen to older people in hospitals, and understanding them ahead of time means you can watch for them and sometimes prevent them.

Delirium is probably the most dramatic. Your parent arrives coherent and oriented. Within hours or a day or two, they're confused. They don't know what day it is. They think they're somewhere else. They're agitated or somnolent. According to the American Geriatrics Society, hospital-acquired delirium affects 30% to 50% of hospitalized older adults, and up to 80% of ICU patients over 65. Most hospitals will tell you it's expected, that it will resolve when your parent goes home. Sometimes it does. Sometimes it doesn't. The Hospital Elder Life Program (HELP), developed at Yale, has demonstrated that non-pharmacological interventions (orientation, mobility, hydration, sleep protocols) reduce delirium incidence by 33% to 40%. You can sometimes reduce it by making the environment less disorienting: a calendar on the wall, letting in natural light, having family present, making sure your parent is reoriented frequently.

Falls happen. The AHRQ reports that falls are one of the most common adverse events in hospitals, and older adults are at highest risk. Your parent is weak, or the medication is making them dizzy, or they don't know where the bathroom is, or they're trying to get up at night without calling for help because they're confused or embarrassed. Then your parent breaks a hip or hits their head, and suddenly the hospitalization is twice as complicated.

Hospital-acquired infections are real. The CDC reports approximately 687,000 healthcare-associated infections in U.S. acute care hospitals annually, with associated mortality of approximately 72,000 deaths per year. Your parent could go in with pneumonia and come out with pneumonia plus a catheter-related urinary tract infection or a Clostridioides difficile (C. diff) infection. The risk increases the longer your parent stays.

Deconditioning happens faster than you'd expect. Three days in a hospital bed without moving much makes muscles weak. Research published in the Journal of the American Medical Association found that older adults can lose up to 5% of muscle strength per day of bed rest. Your parent goes in walking and comes out needing a walker. Or goes in with a walker and comes out needing a wheelchair. By the time anyone thinks to get them up and moving, days have passed and the muscle loss is already compounding.

Medication errors happen. The Institute of Medicine estimates that at least one medication error occurs per hospital patient per day. Someone transcribes a medication list incorrectly. Someone gives the wrong medication or the wrong dose. These events happen in good hospitals with good people. It's a system problem.

Pressure ulcers develop if your parent is immobile and not being turned regularly. A pressure ulcer can start forming within days. Once it starts, it's hard to heal, especially in older people.

Depression and trauma can result from the hospitalization itself. Your parent is sick, scared, in pain, in a strange place, their dignity is being compromised. After discharge, they sometimes have anxiety about being in hospitals again or about their health.

What You Can Do During the Stay

You cannot prevent all of these things. But your presence and your advocacy matter more than you might think.

Be present when you reasonably can be. Your presence alone reduces some of the risks. Your parent is less likely to fall if someone is there with them. They're less likely to be confused if there's a familiar face. Your presence tells them they're not completely alone in this strange place.

Be informed. Know why your parent is in the hospital. Know what they're being treated for. Know what the plan is. This information matters because you can then ask questions if things don't seem to be going as planned.

Be an advocate. If something doesn't seem right, say something. If your parent is confused and nobody's addressing it, mention it to the medical team. If your parent hasn't eaten in a while, ask about it. You're not trying to catch someone in a lie or accuse anyone of negligence. You're trying to make sure things are getting noticed and addressed.

Review the medication list. When your parent is admitted, get a copy of the medications they were on at home. When medications are changed or added, make sure everyone agrees on what's being given. Ask the pharmacist or the nurse about any medication you don't recognize.

Keep the environment less disorienting. Bring a calendar. Bring a clock if the room doesn't have one. Bring something that smells like home, a familiar pillow in a colored pillowcase, for example. Talk to your parent about what day it is, what time it is, where they are, and why they're there. These small things reduce delirium.

Make sure your parent is getting moving. If they're capable of sitting in a chair, they should be. If they can walk, even with help, walking should happen. The longer someone lies in a bed, the harder it is to recover. Work with the physical therapists. Ask about getting your parent up and moving early.

Keep track of what your parent actually eats and drinks. If they're not eating or drinking, the hospital staff needs to know.

Keep a list of your parent's medications, conditions, and allergies. Give it to the nursing staff. Include the names and contact information of their doctors. This becomes especially important if your parent is transferred between units or if shift changes happen.

The Discharge Problem

Here's where a lot of families get ambushed. Your parent is discharged from the hospital and suddenly they're your responsibility, and they're weaker and more fragile than they were before, and nobody gave you a clear plan for what's supposed to happen next.

CMS reports that nearly one in five Medicare patients discharged from a hospital is readmitted within 30 days, with an estimated annual cost exceeding $26 billion. Many of these readmissions are preventable with proper discharge planning and follow-up.

Sometimes your parent is sent home too soon. They're still weak, still recovering. They have a new medication they don't understand. They need physical therapy but can't figure out how to arrange it. They're supposed to follow up with their doctor but the appointment isn't scheduled yet. They get home and within days they're back in the emergency room.

Sometimes the discharge instructions don't make sense. Your parent is supposed to restrict salt but they also have a medication that makes them retain fluid and they're supposed to drink enough water to prevent kidney problems but not too much or something else gets worse. It's contradictory and overwhelming.

Be in the discharge planning process. Before your parent is discharged, talk to the discharge planner or the social worker. Ask: Where is my parent going after this? Do they need physical therapy? Do they need home health nursing? Do they need equipment like a walker or a shower chair? Is any of that being arranged? What are the new medications and what are they for? What side effects should I watch for? What should my parent be able to do when they get home? What should they avoid? What's the follow-up plan with the doctor?

Get instructions in writing. The discharge paperwork should explain what to do, what medications to take, what to watch for, who to call if there are problems.

Schedule follow-up appointments. Don't assume they're scheduled. Call the primary care doctor and the specialists and confirm. CMS's Hospital Readmissions Reduction Program penalizes hospitals for excessive readmissions, which means hospitals are motivated to help with discharge planning if you ask.

Make sure your parent has the medications filled before leaving the hospital. Don't wait.

Planning for the Next Time

If your parent needed hospitalization once, they will likely need it again. The AHRQ reports that readmission rates for Medicare patients remain substantial despite reduction efforts. This isn't pessimism. This is statistics.

While your parent is still recovering, think about what you'd do differently next time. Did communication break down somewhere? Did the discharge go smoothly or was it chaotic? Use what you learned to improve the next experience.

Keep that master medication list updated. Keep a record of conditions, allergies, and previous hospitalizations. If your parent has to go to the hospital again, you'll already have the information organized.

Have conversations with your parent about their preferences for care. If they're very old or very ill, they might have preferences about what kind of interventions they want. Do they want to be resuscitated if their heart stops? Do they want to be on a ventilator? These conversations are hard, but having them ahead of time means your parent's wishes are known.

The reality is that hospitalizations happen, and they can be complicated. But they're more survivable and your parent comes out in better condition when someone is paying attention, asking questions, and making sure the system is actually working well for your parent specifically, not just in general.

Frequently Asked Questions

How common is delirium in hospitalized older adults?
Very common. The American Geriatrics Society reports that hospital-acquired delirium affects 30% to 50% of hospitalized older adults and up to 80% of ICU patients over 65. Delirium is characterized by sudden confusion, disorientation, agitation, or unusual drowsiness. It is caused by a combination of factors including medications, infection, dehydration, sleep deprivation, and the disorienting hospital environment. Non-pharmacological interventions (orientation cues, family presence, early mobility, sleep protection, hydration) can reduce delirium incidence by up to 40%.

Does Medicare cover hospital stays?
Medicare Part A covers inpatient hospital stays, including a semi-private room, meals, general nursing, and drugs as part of the inpatient treatment. For the first 60 days of a benefit period, the patient pays the Part A deductible (which changes annually). Days 61 to 90 involve a daily coinsurance. Medicare also covers skilled nursing facility care following a qualifying hospital stay of at least three days. It's important to confirm that your parent is formally admitted as an inpatient, not held under "observation status," because observation status is covered under Part B with different cost-sharing rules and does not count toward the three-day requirement for skilled nursing facility coverage.

What is the difference between inpatient admission and observation status?
This distinction matters significantly for Medicare coverage. Inpatient admission means the hospital has formally admitted your parent, and the stay is covered under Medicare Part A. Observation status means your parent is technically an outpatient being monitored, covered under Part B, which has different cost-sharing (usually higher out-of-pocket costs) and does not qualify the patient for subsequent skilled nursing facility coverage under Medicare. You have the right to ask the hospital whether your parent is inpatient or under observation, and the Medicare Outpatient Observation Notice (MOON) must be provided in writing if the patient is under observation for more than 24 hours.

How can I prevent my parent from falling in the hospital?
Be present during high-risk times (evenings and overnight). Make sure the call button is within reach and your parent understands how to use it. Ensure non-slip footwear is available. Ask the nursing staff about fall prevention protocols. If your parent is confused, gently remind them to call for help before getting up. Remove obstacles between the bed and bathroom. Ask about bed alarms if your parent is at high fall risk. Advocate for early and frequent mobility with the physical therapy team.

What should I bring to the hospital for my parent?
A written list of all medications, conditions, allergies, and doctors' contact information. Glasses and hearing aids (with cases labeled with your parent's name). Comfortable non-slip shoes or slippers. A familiar pillow or blanket. A clock and a calendar to help with orientation. Entertainment (audiobooks, music) to reduce boredom and anxiety. Your own phone charger, because your vigil might be longer than expected. Do not bring valuables or large amounts of cash.

What questions should I ask at discharge?
Ask specifically: What new medications are being prescribed and what are they for? What medications from home should continue, stop, or change? What symptoms should prompt a call to the doctor or a return to the emergency room? When are follow-up appointments and are they already scheduled? Does my parent need home health care, physical therapy, or any equipment? Are there dietary restrictions? What activity limitations apply? Is there a number to call with questions after hours? Get all of this in writing and make sure you understand it before leaving the hospital.