Hospital acquired deconditioning is an overwhelming physical and/or cognitive decline, which leads to a state of poor functional performance, that is typically acquired as a result of a hospital stay, more common amongst the elderly. This deconditioning has a very concerning impact on the well-being and quality of life of people after they leave the acute care setting. It may result in failure to thrive/cope at home, delay discharge from acute care, increase rate of re-admission etc.
Causes
There are many factors that increase the risk of hospital acquired weakness/deconditioning, and these factors include the factors relating to the patient, the ones relating to the hospitalization and/or a combination of both.
Patient related factors include:
1. Age related changes: older age is often characterized by the emergence of several complex health states commonly called geriatric syndromes. They are often the consequence of multiple underlying factors and include frailty, urinary incontinence, falls, delirium and pressure ulcers.
2. Cognitive decline.
3. Delirium on admission.
4. Frailty: This can be a multisystem ageing syndrome of decreased physiological and functional reserve, where the biological changes of ageing are seen in most tissues and organs.
5. Deficits in basic or instrumental activities of daily living (ADL) at hospital admission or discharge, or both.
6. Reduced functional reserve.
7. Poor mobility and/or use of a gait aid prior to admission.
8. Age related loss of muscle mass and strength.
All the above factors can be complicated by factors relating to the hospitalization itself and these include:
1. Bed rest: A lot of elderly patients, due to some extenuating factors, mostly stay in bed all day during hospitalization. Infact, some studies have shown that, hospitalized older adults spend cumulatively 7 minutes of 24 hours out of bed. The reasons for this bed rest include the medical condition itself limiting their mobility, fear of missing doctor's visits or blood work/tests, while out of the room, poor mobility, difficulty getting out of bed, need for rest after been awake all night, fear of falling, near miss, tethering interventions (e.g. indwelling urinary catheters, IV lines, Opti flow oxygen etc.), healthcare staff prioritising patient safety, especially fear of falls, over patient activity etc.
2. Allostatic Overload: the cumulative effect that chronic stress has on physical and mental health. An example of this during hospitalization is sleep deprivation due to bells going off at night, continuous vital monitoring, noise from other patients etc.
3. Relative inactivity and,
4. Nutritional deficits: Malnutrition is a known risk factor for hospital acquired deconditioning and many hospitalized patients have decreased food intake during hospital stay, thereby setting the stage for hospital acquired deconditioning.
Prevention
To a large extent, some of the risk factors for hospital acquired deconditioning are modifiable and can be addressed by focusing on the cause of the deconditioning. Some of the modifiable risk factors that have to do with inactivity can be addressed by promoting increased activities of the patient while hospitalized. Various health authorities have different programs to help with Hospital Acquired Deconditioning. Programs such as Stop PJ paralysis, breakfast clubs etc. Short hospital stays and early intervention by the physical therapist during the hospital stay also will help to reduce the risk.
Treatment
The acceptable method of therapy starts with recognizing the hospital acquired deconditioning. Physical therapists will help to provide evidence-based therapies. Most evidence is generally supportive of motor control–based gait, balance, and Activities of Daily Living (ADL) training for improving physical performance and frailty markers in older adults.
The physical therapist plays a major role in improving this condition. At Onward Home Physical Therapy, we are near you and we will come to your home and work with you to treat the deconditioning acquired through hospital stay or through certain diseases/illnesses.
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