A full third of ambulatory patients aged 70 and up leave hospital with worse functionality than when they arrived, irrespective of the condition that brought them in. A study by the University of Haifa has isolated the causes, which turn out to have nothing to do with superbugs and everything to do with common sense – languishing for days in bed and spurning the lousy hospital food is bad for you.
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This problem has been noticed around the world. To study it, a team of doctors in Israel looked at 900 senior patients, aged 70+, who were hospitalized in the internal medicine departments of two Haifa hospitals, Rambam Medical Center and Carmel Medical Center, for illnesses that were not associated with loss of functioning (for example, they might have had serious diseases such as pneumonia, but did not undergo surgery or suffer paralysis).
The seniors were treated for their underlying condition – but after leaving hospital, a full third were in a state of reduced function compared to before their hospitalization. A month later, nearly half of those people were not back to normal.
Dr. Anna Zisberg and Dr. Efrat Shadmi from the University of Haifa’s Cheryl Spencer Department of Nursing wondered why, and investigated together with Dr. Nurit Gur-Yaish of the Gerontology research center, student Orly Tonkikh, and Dr. Gary Sinoff of the Department of Gerontology at the University of Haifa. Their findings were published in the Journal of the American Geriatrics Society.
“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, 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,” says Dr. Zisberg. Yet a third of them do.
The study was conducted in cooperation with Dr. Hanna Admi, nursing director at Rambam Medical Center, and Dr. Chen Shapira and Haya Peker, the director and nursing director, respectively, of Carmel Medical Center.
Eating yes, bed rest no
The root of the evil seems to be that very bed rest that people think is advisable for the sick. It isn't always.
A key factor leading to functional decline among older hospital patients, report the scientists, was their reduced mobility while in hospital. If they can get about, there is no reason for patients to stay in bed. But the researchers found that half their subjects never left their room while in hospital – which quickly reduces muscle mass.
"Making sure the patients move around the room and in the ward's corridors, can greatly influence their functioning after hospitalization,” Dr. Zisberg said.
Another problem is almost a cliché – the food. Based on their own reports, the study participants only consumed about 60% of the recommended daily calories while in hospital, though to be fair, it wasn't only because the food was "unfamiliar" – fasting ahead of tests was a factor.
Yet another problem was the tendency in hospitals to use "continence care" - unnecessary use of catheters or adult diapers, which can become easily habit-forming.
Finally, monkeying with sleep habits can cause impairment: prescription of sleep medications when the patient hadn't been using any, or cessation of familiar medications that the patient had been using.
The bottom line is that when you're in hospital, you want to keep moving and don't neglect to eat. To really help a patient, sums up Dr. Zisberg, "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.”