What is hospital acquired deconditioning (HAD)?
In this article, we will describe what is hospital acquired deconditioning (HAD).
It is very common, occurring in 30% of people over 65 years, who have been into hospital.
The problem here is that patients in hospital for treatment, especially older people living with frailty, not only receive treatment for the ailment that they present: they experience what is known as hospital acquired deconditioning (HAD).
The physical manifestations of HAD are well-known, and described below.
Less well-known are the psychological manifestations: confusion, fear, anxiety, low morale, and lack of interest and motivation.
But what is hospital-acquired deconditioning?
Physiologically, an acute hospitalisation causes significant stress on older adults. Within the hospital environment, older adults have prolonged periods of bed rest, relative inactivity, sleep disturbances, and nutritional deficits – all of which make older adults vulnerable to readmission.
During an acute hospitalisation, older adults spend approximately nearly 85% of their hospital stay in bed, and 10% of their time in a chair. Prolonged immobility in hospital is associated with a number of impairments in older adults, including loss of muscle strength (and muscle mass), balance, mobility and cognitive function.
Hospitalisation also is associated with a decline in activity of daily living (ADL) performance; strikingly, hospitalised older adults are 60 times more likely to develop disability in ADLs than those who are not hospitalised.
This decline in function during acute hospitalisation has been labeled as a partially avoidable over the course of the admission; or, more strikingly, as ‘iatrogenic disability’ = disability caused by medical care (i.e. medical care that is meant to make you ‘better’, actually makes you worse.
Discharge planning
It comes as no surprise that discharge teams sometimes overprescribe the amount of care that a patient approaching discharge will need on leaving; or that families who witness the damage to physical and mental health that their relative has suffered, come to feel they may not be able to cope with them at home.
How to prevent hospital acquired deconditioning?
A campaign called ‘Sit Up, Get Dressed and Keep Moving’ has been created to prevent deconditioning.
This includes educational posters, leaflets for patients explaining the benefits of staying active, and illustrated guides outlining chair and bed-based exercises.
These are aimed at maintaining and gaining muscle strength, improving blood circulation, helping mobility progression and supporting overall recovery.
Summary
We have described what is hospital acquired deconditioning (HAD). We hope it has been helpful.
