One in three patients aged 70 and older who are independent in their daily functioning and are admitted for acute conditions, like pneumonia, are discharged from the hospital with functional decline and around one in two report a decline in functioning a month after their discharge, according to a new study conducted by the University of Haifa. “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 s/he entered, but in practice this isn’t always the case,” say Dr. Anna Zisberg and Dr. Efrat Shadmi from the Cheryl Spencer Department of Nursing, who conducted the study, which was recently published in the Journal of the American Geriatrics Society.
The expectation of a person who is hospitalized in an internal medicine ward is to be discharged after his/her health problem is resolved, enabling him/her 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, 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. 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 Department of Gerontology, Faculty of Social Welfare and Health Sciences at the University of Haifa, sought to determine what is it about the hospitalization that was causing decline in older adults functioning. 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. 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%), 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,” says Dr. 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. According to the researchers, patients often mistakenly think that if they’re sick, they ought to be in bed, and around half of the patients didn’t leave their rooms during their entire hospital stay. “Lack of mobility leads to reduced muscle mass and is liable to cause older people difficulty in daily functioning and other complications,” says Dr. Zisberg. “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 nutrition. On average, study participants reported consuming only 60% 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 periods of fasting needed 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 a patient and do things for him/her,” says Dr. 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 say. “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.”
They added that a follow-up study is being conducted at both hospitals and changes have been made in the treatment protocols for older hospitalized adults.