Avoiding the risk wave from the age wave

The U.S. population is aging at an unprecedented rate. In 1940, less than 7% of Americans were over the age of 65. By 2020, that percentage more than doubled to nearly 17%. Projections reveal an even faster rate of growth in the coming decades, according to data from the U.S. Census Bureau. This seismic demographic shift has profound implications for hospitals, health systems, and medical practices.  

Hospitalized geriatric patients present complex clinical, psychosocial, and functional needs. They are at increased risk for falls, delirium, medication errors, functional decline, and hospital-acquired conditions. Each of the risks left unaddressed can lead to longer lengths of stay, avoidable readmissions, regulatory penalties, and increased liability exposure.  

For healthcare leaders, the message is clear: Proactive identification and mitigation of geriatric-specific risks is now a critical component of patient safety, quality improvement, and financial stewardship.  

This article identifies the risks presented when caring for an increasing number of geriatric patients and the role of clinical audits in avoiding and mitigating those risks. 

The role of clinical audits in geriatric risk reduction 

Clinical audits are a proven method for detecting vulnerabilities in patient care before they result in harm. A robust geriatric-focused audit program can: 

• Identify systemic weaknesses in clinical processes, staffing, or documentation.  
• Benchmark performance against national evidence-based standards, such as those from the American Geriatrics Society  and the AGS’ Beers Criteria for proper medication use.  
• Spot organization-specific risks uncovered through both data analysis and direct case review.  
• Support compliance with rules, regulations, requirements, and standards from the Centers for Medicare & Medicaid Services, The Joint Commission, state health departments, and more. 

Key risk domains for geriatric patients 

When internal auditors evaluate geriatric care, we recommend auditors focus on two high-impact domains that are correlated with adverse outcomes and liability exposure. Below are the domains along with and the specific risks associated:  

Domain: Clinical care risks 

• Falls and fall-related injuries. A leading cause of harm in hospitalized older adults. Falls are often preventable with consistent protocols.  
• Delirium. Frequently underdiagnosed, leading to avoidable complications and prolonged stays.  
• Polypharmacy and medication errors. High rates of adverse drug events, interactions, and inappropriate prescribing.  
• Functional decline. Lack of early mobility programs, delayed therapy interventions, or inadequate assistive devices.  
• Malnutrition and/or dehydration. Missed nutrition screenings or failure to escalate care after providers identify deficits.  
• Pressure injuries. Gaps in prevention bundles and inconsistent skin integrity assessments.  

 

Domain: Operational and coordination risks 

• Inconsistent use of evidence-based assessment tools, e.g., Comprehensive Geriatric Assessment, Hendrich II Fall Risk Model.  
• Gaps in care transition planning that could lead to readmissions (e.g., medication management, social determinants of health).  
• Limited interdisciplinary communication.  
• Inadequate staff training in geriatric-specific care principles. 

Leveraging data for precision risk identification  

A key differentiator in Kodiak’s approach to clinical risk and clinical audits is our integration of trending data with clinical audit observations. This dual lens allows us to: 

• Observe hands-on care to validate it aligns with procedures and results.  
• Identify risks that have not yet surfaced on internal dashboards. 
• Detect patterns in adverse events by unit, provider, or shift.  
• Isolate root causes behind high-cost claims or sentinel events.  
• Compare hospital outcomes with national and peer benchmarks.  

For example, while an organization may identify patient falls as a risk area, our audits might reveal more details such as most falls occur within 24 hours of admission or with patients receiving certain medications. These insights can lead to more targeted interventions and rapid risk reduction.  

Typical findings in geriatric risk audits 

Every hospital, health system, and medical practice is unique as are the geriatric patients treated by those facilities. Despite those differences, we see patterns culled from our risk assessments. Here are some common risks identified during our clinical audits: 

• Inconsistent medication reconciliation at admission or discharge.  
• Missing or outdated fall risk reassessments after clinical changes.  
• Lack of documented cognitive screening or follow-up actions.  
• Delayed initiation of physical therapy for mobility-impaired patients.  
• Absence of standardized delirium prevention protocols.  
• Weaknesses in discharge planning for patients without strong social support systems.  

To address these risks, we recommend that geriatric care providers take the following actions: 

• Align all policies with AGS, CMS, and The Joint Commission rules, regulations, requirements, and standards.  
• Embed standardized geriatric assessment tools into electronic health record systems.  
• Conduct daily interdisciplinary rounds with a geriatric focus.  
• Target staff education on high-risk geriatric syndromes.  
• Enhance care transition workflows that integrate community resources.  
• Implement and use real-time monitoring dashboards for geriatric safety metrics.  

The measurable impact of proactive clinical auditing 

Hospitals, health systems, and medical practices that integrate geriatric-specific clinical audits into their safety programs can benefit from numerous clinical, financial, and operational outcomes, such as: 

• Reduced incidence of falls, delirium, and medication-related events.  
• Shorter stays and fewer avoidable readmissions.  
• Improved patient and family satisfaction scores.  
• Lower malpractice exposure and regulatory penalties.  
• Stronger performance in value-based purchasing and quality incentive programs.  

Kodiak is your partner in geriatric safety 

At Kodiak, we combine data analysis with real-time observations and chart review to uncover risks that are inherent to the aging population and unique to each healthcare organization’s operational environment. We deliver a comprehensive, data-informed approach to geriatric patient safety audits, incorporating:  

• Tailored audit design. Built around your facility’s patient population and operational structure.  
• Data-driven insights. Integration of claims, quality, and clinical process data for precision targeting.  
• Actionable recommendations. Customized, measurable, and aligned with evidence-based best practices.  
• Sustainable monitoring. Ongoing tracking to ensure long-term success.  
• Education and support. Training programs for clinical and leadership teams.  

As the geriatric population grows, the risks grow, but so do the opportunities for improvement. With Kodiak as your partner, you add a resource to your team that not only can identify risks but help you close the gaps to prevent harm now and in the future.