I read Park and Jung's article¹⁾ with great interest, as it is clear that it's time for the definition of the concept of "hospitalization-associated disability" to be clarified. Additionally, this article was particularly valuable in prompting reflections on the human rights of hospitalized older patients within the healthcare system, especially as our society entered a super-aged status in 2025. According to a recent survey by the Ministry of Health and Welfare, medical expenses for individuals aged 65 and over account for approximately 43.3% of total healthcare costs, and hospitalization expenses for older adults represent about 50% of all hospital admission costs.²⁾ These statistics indicate that most hospital beds are currently occupied by older adults, highlighting the necessity of focusing attention on the physical and psychological pain experienced by older inpatients.

Even when hospitalization is intended for treatment, the experience of being confined to a specific environment for an extended period can significantly impact an individual's life. Older patients, who typically have fewer coping resources (such as health status, economic conditions, and levels of social support) to deal with disruptions from familiar environments, fear of illness, and loss of autonomy, should be monitored more carefully than other age groups.

Previous studies have demonstrated that environmental factors in hospital settings—such as sleep disturbances, noise, uncomfortable lighting, and diminished communication with medical staff—not only affect the psychological well-being of older adults, but are also associated with hospitalization-associated disability (HAD).^3,4) These findings strongly support the central theme of Park and Jung’s article,¹⁾ which emphasizes the importance of addressing the sense of isolation experienced by hospitalized older patients.

More specifically, isolation of older adults according to hospitalization environment is associated with pain⁵⁾ and significantly correlates with serious physical health risks, including heart disease (29%), stroke (32%), impaired immune function, and a 50% increase in premature death.⁶⁾ Patients recognize that forming bonds in an isolated environment is difficult. This leads to the emotional state of "sense of isolation."⁷⁾ Such a sense of isolation has long been reported as a psychological factor negatively impacting mental health, contributing to depression, anxiety, anger, feelings of loss, stress, social withdrawal, suicidal behaviors, and even increasing dementia risk by as much as 64%, even when interventions are implemented.⁸⁾

These results suggest a hypothesis that the sense of isolation, which often develops after hospitalization, could be considered one manifestation of HAD. Its severity may significantly influence both the recovery process and the quality of life of older adults who spend extended periods in the hospital. Although psychological factors like isolation have not been thoroughly explored in relation to HAD, recognizing and responding promptly to the sense of isolation in hospitalized older adults may be a critical first step in preventing the onset of HAD.³⁾

However, older patients often perceive themselves as vulnerable in therapeutic relationships with medical professionals and tend to be reluctant to share their inner thoughts, a trait notably prevalent among Korean older adults. Furthermore, the emotional state of isolation can be challenging to measure as it is frequently obscured by physical ailments.

Therefore, they argued for the need to focus on the lived experiences of older inpatients and to clarify, measure, and intervene on the concept of "sense of isolation" among the older population. In addition, healthcare providers, including physicians and nurses, must pay greater attention to modifiable risk factors—such as prolonged confinement to the patient room⁴⁾—that may impact functional outcomes in older adults. Lastly, multidisciplinary collaboration and institutional efforts to establish age-friendly hospital environments are essential for mitigating the sense of isolation in hospitalized older adults.