Staying in bed, unnecessary use of urinary catheters, taking sleeping pills and inadequate nutrition are some of the reasons why independent people over 70 who are hospitalized for acute problems return home with functional decline.
This important conclusion was reached by a University of Haifa study just published in the Journal of the American Geriatrics Society.
“We wanted to examine why people who come into the hospital on their feet sometimes leave in a wheelchair,” said Dr. Anna Zisberg and Dr.
Efrat Shadmi of the University of Haifa’s nursing department, who performed the study.
One in three patients aged 70 and older who are independent in their daily functioning and are admitted for acute conditions, such as pneumonia, is discharged from the hospital with functional decline. About half report a decline in functioning a month after their discharge.
“A patient who is admitted for a serious illness, like complications from pneumonia or exacerbation of a heart condition, expects to leave the hospital in a better state than the one he or she entered, but in practice this isn’t always the case,” said the authors.
The expectation of a person who is hospitalized in an internal medicine ward is to be discharged after the medical problem is resolved, enabling the patient to return to their normal functioning.
“When a man of 78, who was able to walk, go to the bathroom and eat independently before the hospitalization is admitted for three or four days to be treated for arrhythmia [irregular heart rhythm], there is no apparent explanation for why after his condition is treated, he should become dependent, need a cane to walk, and require adult diapers,” noted Zisberg. “But from studies conducted around the world, it seems that this is exactly what happens to many people over age 70.”
As a result, the researchers, together with Dr. Nurit Gur-Yaish of the gerontology research center, research student Orly Tonkikh and Dr.
Gary Sinoff of the university’s gerontology department sought to determine what about hospitalization was causing older adults’ decline in functioning. The study was conducted in cooperation with colleagues at Rambam and Carmel medical centers.
Participants included about 900 people aged 70 or older who were hospitalized in the internal medicine departments of both hospitals for illnesses that were not associated with loss of functioning (for example, they did not undergo surgery or suffer paralysis).
The findings showed that a third of the patients, when discharged, were in a state of reduced function compared to the period preceding the hospitalization, and nearly half (46 percent), reported reduced functioning as late as a month post-discharge. “We were interested in what happens during the hospitalization that causes people who were independent to experience declines in their basic functioning,” said Shadmi.
The findings showed that one of the main factors leading to functional decline among older hospitalized patients was their reduced mobility while in the hospital.
A“This study shows, for the first time, that in addition to the many other risk factors present before and during the hospitalization itself, mobility is a significant factor, and making sure the patients move around the room and in the ward’s corridors can greatly influence their functioning after hospitalization.”
Other factors found to be significantly associated with post-hospitalization functional decline was the unnecessary use of catheters or adult diapers for urination, use of sleep medications (either new use of sleep medications or cessation of pre-hospitalization routine use of sleep medications) and inadequate hospital food. On average, study participants reported consuming only 60 percent of the recommended daily calories during their hospitalization.
The reasons for reduced nutrition included the unfamiliar taste of the food, a lack of appetite and fasting before various tests.
According to the researchers, the most important recommendation is to encourage the patient to stay mobile while hospitalized, even if it means walking through the corridors or around the room.
“Sometimes we want to help patients and do things for them,” said Zisberg. “But if we really want to help, it’s best to encourage the patient to be as independent as possible.
Moreover, it’s important for the patient to maintain as full and balanced a diet as feasible, to facilitate the body’s optimal recovery processes.”
“Post-hospitalization functional decline has been extensively shown to affect a broad range of adverse outcomes, including institutional care, falls, decreased quality of life and even death,” the researchers said. “Identification of a comprehensive set of in-hospital risk factors that may be amenable to change has important implications for the prevention of such deleterious effects.”
A follow-up study is being conducted at both hospitals and changes have already been made in the treatment protocols for older hospitalized adults.
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