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A Threat to Independence

Earlier this month we celebrated our nation’s Independence Day. Personal independence allows us to proceed through our daily lives without hindrances.  The potential of an altered level of independence is one reason people fear aging. All too frequently an event which threatens the independence of older adults is hospitalization. The reason why may be a surprise.

Advances in medical knowledge are allowing people to live longer.  However, they are frequently living with one or more chronic illnesses which may require periodic treatment in a hospital. Illness and hospitalization are commonly equated with a need for rest. But when older adults are hospitalized, one of the worst things they are likely to 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 percent decrease in blood volume within 24 hours of bedrest, and 10 percent 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 percent loss of muscle strength per day with total inactivity

3 percent loss of muscle mass in the thigh muscles within one week

40-50 percent 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 that occur with decreased activity levels and bedrest. A few of the potential complications that 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 generally 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 care facility placement and an earlier death.

Is the importance of physical activity sinking in yet? Unfortunately for hospital patients, mobility isn’t often a focus of care.

Professionals must make sure that each patient receives and that documentation is completed for ordered medications, treatments, tests and meals. A walk in the hall becomes an intervention that 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.

In addition, the staff, visitors, and volunteers who “help” patients by attending to their every need (and because it is quicker than allowing someone who is moving more slowly to do it themselves) are in reality doing the patient an injustice by not encouraging as much self-participation as possible. Research has demonstrated that changes to an individual’s daily routine which occur during hospitalization can lead to depression, poor sleep quality, functional decline, and a decrease in overall well-being.

One daily physical therapy session is often not enough to help a patient maintain or improve their balance, strength and mobility, all of which are essential if an older adult wants to be discharged home. Dr. Seth Landefeld, chairman of the Department of Medicine at the University of Alabama at Birmingham School of Medicine, was quoted in an 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.”

If you are fortunate enough to rarely require hospitalization, you aren’t completely off the hook. Some of the same complications which result from inactivity during a hospitalization can also occur when older adults are inactive in their own homes.

A heart-thumping, hard-breathing exercise regimen is not possible for many people, but everyone can benefit from regular movement throughout the day. If independence sounds like a quality you would like to keep; when your condition permits, insist on getting out of bed when you are hospitalized and avoid the temptation of being a couch potato at home.

Karen Kaslow, RN, BSN