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Abstract
Older adults are at particular risk for injuries associated with hospitalization and
the rate of adverse events increases significantly with age. The purpose of this paper
is to review factors associated with the development of adverse events in hospitalized
older adults, especially those factors that contribute to cascade iatrogenesis. Cascade
iatrogenesis is the serial development of multiple medical complications that can
be set in motion by a seemingly innocuous first event [Rothschild, J.M., Bates, D.W.,
Leape, L.L., 2000. Preventable medical injuries in older patients. Archieves of Internal
Medicine 160 (October), 2717-2728]. Research has examined how patient characteristics
may lead to cascade iatrogenesis, but existing conceptual models and research have
not considered the role of nursing care. Using the outcome postoperative respiratory
failure as an example, we expand on existing knowledge about factors associated with
older adults' risk for developing this complication by presenting a conceptual model
of events that may trigger the initial cascade and the nursing care variables that
may prevent or mitigate these risks. We believe that this model will help guide research
in this area and enable clinicians to identify systemic failures and develop targeted
interventions to prevent their occurrence.