Safety Without Age Limits: Why Older Patients Deserve More Than Our Current Systems Deliver

Safety, equity, and person-centered care have long been core aspirations in our industry. Yet even as we deepen our commitment to these principles, one reality stays largely in the background: Older patients are at a disproportionate risk of harm. And too often, we simply don't see it-or act on it as urgently as we should.

When we look at age and safety data together, the gaps in how we deliver care to this patient population become clear. But it also gives us a powerful opportunity to redesign safety systems, while honoring the dignity and complexity of the Human Experience later in life.

CMS puts age-friendly care on the map

One promising step came in January, when the Centers for Medicare & Medicaid Services (CMS) introduced its Age-Friendly Hospital Measure.

The measure evaluates how well hospitals care for patients age 65 and older by focusing on five key domains:

1. Patient goals
2. Medication management
3. Frailty screening
4. Social vulnerability
5. Leadership commitment

Hospitals participating in Medicare's Inpatient Quality Reporting (IQR) Program must now attest to whether they have protocols in place across each.

By bringing visibility and structure to the elements of age-friendly care, CMS is signaling that meeting the needs of older adults is absolutely essential to delivering high-quality care.

A safety and equity imperative

The Press Ganey Patient Safety Organization (PSO) analyzed over 500 million safety events in 2024 to identify which patient groups are most vulnerable to breakdowns in care. Older adults-particularly those age 85 and up-are at increased risk of more (and more severe) serious safety events. In numbers, they're 1.28x more likely to experience serious safety events than younger patients.

Clinical complexity meets systemic vulnerability

The most common safety events affecting our eldest (85+) patients involve care management, falls, and medication-issues that reflect both clinical complexity and systemic vulnerability. These events are concentrated in the operating room, cardiac catheterization laboratory, long-term care hospitals, and medical-surgical units.

Further analysis points to critical breakdowns in the care continuum: "Patient monitoring and assessment" and "coordinating care and services" emerge as the most frequent key processes contributing to serious safety events. This highlights the need for deeper cross-disciplinary coordination and the importance of embedding safety best practices in high-acuity environments.

Even as data sharpens our understanding of risk, one of the most insidious threats to safety remains under-addressed: ageism.

In fact, in our analysis of patient comments, age emerged as the most common theme when patients described experiencing bias in their care. Implicit bias toward older adults, particularly those who appear frail or cognitively impaired, can shape how we engage, listen, and act. Too often, their voices are sidelined. Care plans may prioritize efficiency over empathy. And what's important to them is left unspoken-or unheard.

We see this in patient experience data: HCAHPS scores decline among patients 80+, especially in empathy, information sharing, and discharge planning, which directly connects to the safety concerns around care coordination. More than a third of these patients (34.4%) report feeling less safe, compared to 20-30% in younger generations. This drop goes hand in hand with less confidence in the care site as well as lower "Likelihood to Recommend" (LTR) scores.

Impact of safety on "Likelihood to Recommend" (LTR)

Calling this a "dip" in satisfaction doesn't scratch the surface. These are signals of emotional harm and missed opportunities to build trust.

We cannot meaningfully improve safety if we continue to overlook how age bias compromises both care quality and patient dignity. Addressing ageism is core to building systems that are equitable, reliable, and worthy of the trust patients place in us.

Embedding age-informed safety into high reliability culture

If we are to move from compliance to cultural transformation, we must integrate high reliability principles into the very fabric of how we care for older adults. This means treating aging itself as a complexity to be designed for-through policies, workflows, technology, and a safety-first mindset.

• Preoccupation with failure: Segment quality, safety, and experience data routinely to better understand risks to elderly patients.
• Sensitivity to operations: Use daily huddles and interdisciplinary rounds to elevate real-time risks to aging patients.
• Equity-driven root cause analysis: Include age, race, and social vulnerability factors in cause analyses.
• Technology integration: Leverage tools like Epic segmentation and HL7 data flows to flag age-specific safety risks early.
• Patient and family voice: Use patient and family advisory councils (PFACs) and solutions like our community advisor to ensure the perspectives of older adults and their families directly inform safety priorities and care design.
• Download our nursing bundle : Implement proven best practices, including bedside shift handoff, purposeful interval rounding, and nurse leader rounding to transform care.

Resources like Press Ganey's HRP dashboards and IHI's 4Ms implementation toolkits can help organizations build systems that see-and serve-older adults more effectively.

Designing safety to last a lifetime

The safety of older patients is a bellwether for how inclusive, responsive, and humane our healthcare systems truly are. But for far too long, the risks these patients face have lived in the margins of our safety agendas.

That's beginning to change. Adopting the CMS Age-Friendly Hospital Measure is an important milestone. Still, it's only the beginning. We must reframe safety and aging as an equity imperative-one that deserves care designed with intention, not assumption, and designed for complexity, not convenience.

In a truly safe system, there are no invisible patients. Every voice matters, and every voice is heard. Every story counts. Because, as we know, there is no such thing as acceptable harm-at any age.

To learn more about Press Ganey's safety, high reliability, and equity solutions, reach out to our team of experts.