Last week’s article discussed the role of diet and activity in helping older adults maintain their independence. An event in which activity levels have an extensive influence on the outcome of an older adult’s future is hospitalization. Illness is commonly equated with a need for rest, however, when older adults are hospitalized, one of the worst things they may receive is too much rest.
Why is rest bad for your health and independence? Changes in multiple body systems can begin within 24 hours of bedrest. A nurse from the Geriatric Research Education and Clinical Centers (operating under the Department of Veterans Affairs), reported the following in a presentation on the consequences of bedrest:
- 5% decrease in blood volume within 24 hours of bedrest, and 10% decrease in 10 days. One result of this decrease is dizziness when rising to a sitting or standing position, which can lead to falls and fractures
- Increased resting heart rate (the heart is working harder)
- 1-3% loss of muscle strength per day with total inactivity
- 3% loss of muscle mass in the thigh muscles within one week
- 40-50% of older adults become incontinent after one day in the hospital (in addition to decreased activity, medications and environmental factors contribute to this issue)
- Changes in the way the body processes glucose by day 3
These are only some of the changes which occur with decreased activity levels and bedrest. A few of the potential complications which can develop as a result of these changes include pneumonia, blood clots, skin breakdown, constipation, and cognitive changes/delirium. What may initially begin as a short term hospitalization for a healthy older adult can quickly turn into a complicated and lengthy illness. If an older adult is debilitated even before a hospitalization, this event may take the individual over the edge of the cliff and into a progressive decline, resulting in permanent facility placement or even an earlier death.
Is the importance of physical activity sinking in yet? Unfortunately for hospital patients, mobility isn’t often a focus of care. Staff members must make sure that each patient receives their ordered medications, treatments, tests, and meals, and walking in the hall is an intervention which is relegated to “if there is time”. If a patient has been sitting in a chair for a couple of hours, he/she may be too tired to walk by the time a staff member is available to assist him/her. One daily physical therapy session is often not enough to help a patient maintain or improve their strength and mobility, both of which are essential if an older adult wants to be discharged home. Seth Landefeld, chairman of the Department of Medicine at the University of Alabama at Birmingham School of Medicine, was quoted in a recent article in Kaiser Health News referring to hospital care as a “smart bomb approach” in which “We blow away the disease, but we leave a lot of collateral damage.”
One of our articles from last year focused on how several local hospitals are utilizing the NICHE program (Nurses Improving Care for Healthsystem Elders) to educate staff about the specialized needs of older adults. Some hospitals around the nation are going even farther and instituting “ACE” units: Acute Care for Elders. These units provide care which is designed to help treat the illness AND prevent functional decline in older adults. The environment is more home-like, mobility is a top priority, and the plan of care for each patient is designed by a multidisciplinary team of professionals who work together to help the patient achieve maximum health and functioning. In a usual hospital setting, a patient may be seen by professionals from multiple disciplines, but they are usually functioning independently of each other.
Data is available which demonstrates that these units are helping hospitals save money or are budget neutral. More importantly, they are achieving more positive outcomes for their patients with higher patient satisfaction, shorter hospital stays, and fewer discharges to long-term care facilities. Since these units are meeting an important goal of helping older adults maintain their independence, one may question why more hospitals aren’t developing their own ACE units. Literature suggests that these units require a higher level of commitment from hospital administration and the various professional departments because of their different design and culture from traditional hospital units. A nationwide shortage of geriatricians, physicians who specialize in the care of older adults, is also a contributing factor as these professionals are needed as leaders of ACE units.
Until the ACE approach becomes more common, families need to advocate for their older loved ones to be up and moving when they are hospitalized, and older adults themselves need to make the additional effort required to get out of bed and take those walks in the hall. If bedrest is a required part of treatment, ask what can be done to help prevent loss of muscle strength and the other complications of immobility. Your independence is at stake.
Karen Kaslow, RN