Hospitalization: A Risk Factor For Functional Decline

Hospitalization can lead to functional decline in older adults due to several factors. Firstly, older patients often experience reduced mobility and activity levels during hospitalization, which can result in deconditioning, muscle weakness, and reduced exercise capacity. Additionally, the negative effects of bed rest, such as pressure injuries, dehydration, malnutrition, and delirium, can further contribute to functional decline. Moreover, acute and chronic illnesses can make older adults more vulnerable to functional decline during hospitalization. Furthermore, cognitive decline associated with hospitalization can also lead to worsening medical conditions, increasing dependency, and institutionalization. Early identification of high-risk patients and interventions focusing on physical, social, and psychological domains can help prevent hospital-related functional decline in elderly patients.

Hospitalization leads to reduced mobility and activity levels

Hospitalization can lead to reduced mobility and activity levels, particularly in older adults. This is a well-established phenomenon, with the average hospital stay for patients aged 65 and older being 5.7 days. During this time, older patients are at risk of functional decline due to decreased mobility and activity levels. This can be caused by a number of factors, including the negative effects of bed rest, medication side effects, and hospital treatment measures such as invasive lines and catheters. Bed rest during hospitalization has been linked to immobility, accelerated bone loss, dehydration, malnutrition, delirium, sensory deprivation, isolation, and incontinence.

Older adults are at a higher risk of adverse physiological consequences during acute illness, including functional decline. Frailty, characterized by musculoskeletal weakness and other losses in structure and function, has been attributed to decreased activity levels and is more common in older adults. Additionally, advanced age, acute and chronic diseases, functional limitations, and deconditioning contribute to the vulnerability of older adults to functional decline during hospitalization.

Functional decline during hospitalization is a common issue, with 35% of 70-year-old patients experiencing a decline in comparison to their pre-illness baseline. This percentage increases with age, highlighting the need for preventative measures and early interventions. To address this issue, some hospitals have implemented innovative programs such as the Prevention and Reactivation Care Program (PReCaP), which aims to reduce hospital-related functional decline through multidisciplinary and integrated interventions.

To mitigate the risk of functional decline in hospitalized older adults, comprehensive geriatric assessments of physical, psychosocial, and functional status upon admission are recommended. Encouraging activity during hospitalization through structured exercise, progressive resistance strength training, and walking programs can also help. Implementing early mobilization protocols for acute and critically ill patients is crucial, as functional decline can occur as early as the second day of hospitalization.

By following these evidence-based practices, healthcare providers can improve the quality of care and outcomes for hospitalized older adults, reducing the impact of functional decline on their patients' lives.

Bed rest has negative consequences for elderly patients

One of the key negative consequences of bed rest for elderly patients is a decrease in muscle strength and functional capacity. This can lead to a higher risk of fall injuries, disability, and mortality. Tendons, ligaments, and articular cartilage need movement to stay healthy and can deteriorate when a patient is immobile. In addition, bed rest can lead to a reduction in total lung capacity and residual volume due to the restriction of chest cavity movement. This can result in a lower concentration of oxygen in the blood, which can produce small disabilities in elderly patients.

Furthermore, bed rest can result in cardiovascular complications, such as decreased heart volume and increased cardiac workload. The formation of pressure ulcers is also a common issue during bed rest, particularly in elderly patients, and can lead to further immobilization. Bed rest is also associated with reduced taste, smell, and loss of appetite, which can have negative consequences for the intestinal tract.

The negative consequences of bed rest for elderly patients can also include psychological and social challenges. Feelings of helplessness, isolation, and dependence on others can arise, contributing to the development of depression and anxiety. Additionally, shorter hospital stays for elderly patients can make it more challenging to properly assess and address their care needs, both during hospitalization and after discharge.

To mitigate the negative consequences of bed rest, healthcare professionals should carefully assess the need for bed rest and consider alternative therapies or rehabilitation exercises. In-home health services can provide benefits such as improved patient comfort, cost-effectiveness, and continuity of care. Physical therapy and safe exercise programs can help elderly patients maximize their recovery and minimize muscle atrophy, bone density loss, and cardiovascular complications.

Functional decline is associated with hospital readmission, institutionalization, and mortality

Functional decline is a common complication of hospitalization, particularly in older patients. It refers to the inability to perform usual activities due to weakness, reduced muscle strength, and decreased exercise capacity. This decline is associated with hospital readmission, institutionalization, and mortality, and those who experience it may struggle to access post-discharge medical care.

Hospitalization can lead to functional decline through various factors, including reduced mobility and activity levels, the negative effects of bed rest, medication side effects, and invasive treatments that limit movement. The risk of functional decline increases with age, and older adults are more susceptible to adverse physiological consequences during acute illness due to frailty and other age-related factors.

The impact of functional decline on patients' lives and healthcare systems is significant. It results in greater reliance on community support services and can lead to higher healthcare costs. Additionally, functional decline can contribute to a downward spiral of worsening medical conditions, increasing dependency, and care needs.

To address these issues, healthcare providers have implemented various strategies, such as the Prevention and Reactivation Care Program (PReCaP), which focuses on early identification of high-risk patients and multidisciplinary interventions. This program aims to improve functional status, reduce hospital readmissions, enhance mental well-being for caregivers, and lower mortality rates.

Furthermore, best practices for reducing functional decline in hospitalized older adults include conducting comprehensive geriatric assessments, encouraging activity during hospitalization, and implementing early mobilization protocols for acute and critically ill patients. These strategies can positively impact patients' function and quality of life.

Cognitive decline is associated with an increased risk of hospitalization

Cognitive decline is a common occurrence in older adults, and it poses a significant burden on public health. Hospitalization has been found to be a contributing factor to cognitive decline, particularly in the elderly. Research has indicated that hospitalization can lead to a decline in physical fitness, which, in turn, may result in cognitive decline. The relationship between stress, cognition, and neuro-chemicals is also a factor that cannot be overlooked. Hospitalization can be a unique stressor, as the psychological distress of being in a hospital is often compounded by the physical stress of the illness or injury that precipitated the hospitalization.

Several studies have found a strong association between hospitalization and cognitive decline. One study, which interviewed 1,870 older residents at 3-year intervals for up to 12 years, revealed that cognitive decline accelerated significantly after hospitalization. Another study, which examined the relationship between hospitalization and cognitive decline in older adults, found that the rate of cognitive decline was moderately correlated with the rate of decline before hospitalization. This suggests that the impact of hospitalization on cognitive function may be cumulative.

The type of hospitalization and the specific circumstances surrounding it may also play a role in the risk of cognitive decline. For instance, emergency or urgent hospitalizations may pose a greater risk than elective hospitalizations. Additionally, the presence of delirium, which is a common occurrence after hospitalization, has been associated with an increased risk of cognitive impairment and dementia. However, it is important to note that delirium is not the only factor contributing to the relationship between hospitalization and cognitive decline, as only a proportion of patients who experience delirium go on to develop cognitive issues.

Furthermore, certain medical conditions and indicators of physical health, such as diabetes, chronic obstructive pulmonary disease, frailty, and body mass index, have been linked to late-life cognitive decline. Hospitalization may also increase the risk of losing independence in daily living activities, which can further impact cognitive functioning. While the exact nature of the relationship between hospitalization and cognitive decline is complex and not yet fully understood, it is clear that hospitalization can be a risk factor for cognitive decline, especially in older adults.

Geriatric interdisciplinary team training can help prevent functional decline

Geriatric Interdisciplinary Team Training (GITT) is an important component of ensuring quality geriatric care delivery, which can be complex and time-intensive. Geriatric patients often experience reduced mobility and activity levels during hospitalization, leading to functional decline. This decline includes changes in physical status and mobility, and in some cases, cognitive decline.

GITT aims to address these issues through interprofessional collaboration and evidence-based practices. Graduate students from nursing, midwifery, social work, and pharmacy, along with preceptors, participate in the program. They undergo training in interprofessional collaboration and focus on providing care to complex and frail older adults with multiple chronic conditions.

The GITT program also encourages activity during hospitalization with structured exercise, progressive resistance strength training, and walking programs. Early mobilization for acute and critically ill patients is implemented based on established protocols. Additionally, the use of assistive devices, such as hearing aids, glasses, and appropriate footwear, is ensured to encourage mobility and prevent falls.

By integrating GITT with geriatric specialists and acute care models, hospitals can promote recovery, optimize reserve, maximize safety, and support independence among geriatric patients. This comprehensive approach to geriatric care can help prevent functional decline and improve patient outcomes during and after hospitalization.

Furthermore, GITT can enhance transitional care by facilitating early physician follow-up, which is crucial in preventing poor outcomes and reducing hospital readmissions, institutionalization, and mortality rates associated with functional decline.

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