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Dr Amit Arora, Consultant Geriatrician at University Hospitals of North Midlands NHS Trust, tells us his thoughts on #EndPJParalysis and the impact the campaign is having so far.
Many frail older people spend up to 83% of their inpatient time in bed and a further 12% in a chair. Most older people walk only a few steps a day during their hospital stay.
This inactivity leads to ‘deconditioning’,which causes people to lose fitness or muscle tone, especially through lack of exercise.
How can we prevent deconditioning?
In older people it could be prevented by activities of daily living (ADLs), such as washing, dressing, walking, standing, and maintaining hydration and nutrition — which could amount to a level of exercise sufficient to maintain their usual health.
If anyone were in bed for 20 hours a day for 10 days, the body would get stiff and unable to move. This induces pain due to muscle stiffness, which initiates a vicious cycle of immobility, deconditioning and frailty is further exacerbated. Is that what we want for our frail older parents, relatives, friends and patients?
Encouraging patients to do their ADLs used to be routine in hospitals. Though we know muscle wasting starts within 24/48 hours of hospital admission, we often focus on rehabilitation after treatment of the acute problem.
This leads to delayed discharges, increased risks of hospital acquired complications and leaves patients in a state of excessive dependency, unable to return home in time. Many patients often never return home.
This could be the difference between someone going home or into a care home.
Professor Brian Dolan, the leading figure behind #EndPJparalysis.
The benefits of activity and exercise are already proven. Which implementation strategies will work at scale remains to be seen. The #EndPJParalysis is a national drive supported by NHS Improvement, NHS England and many other organisations, to get patients dressed in their own clothes, walk on the wards, to ‘sit up, get dressed, keep moving’ to prevent deconditioning.
It is leading to heightened awareness and may lead to prevention of deconditioning, thus improving quality and outcomes for frail older people.
The 70-day #EndPJParalysis challenge to achieve a million days of patients up, dressed and moving while in hospital started in April 2018, to help mark the 70th birthday of the NHS.
This is not a new idea. We’ve long known about the risks of immobility. What’s great about the #EndPJParalysis movement is it didn’t originate from a central mandate or a meeting room. It’s simply the right thing to do and the message is simple. For those patients that can get up, dressed and moving they should be given the opportunity to do so which will in many cases help them to return #homefirst sooner.
Professor Brian Dolan, the leading figure behind #EndPJParalysis.
It is heartening to see so much involvement from key frontline staff, who are the unsung heroes. Our remarkable staff are worthy of sincere congratulations because they are going beyond their day jobs to bring about a societal change, something no amount of money could accomplish. My own involvement is borne out of personal experience of an emergency appendectomy and subsequently in my professional clinical practice as a geriatrician. It was therefore largely inspired by patient stories and experiences and was developed for the patients. Many patient groups and charities have started to participate as well and it has been extremely well received.
Celebrating NHS70 and #EndPJParalysis
Perhaps one further key step would be to make deconditioning a reportable harm like we do for C difficile infection, MRSA, pressure sores and falls. The UK could be the first country to do this. This will require further work, data collection, staffing, deconditioning care bundles and much more.
#EndPJParalysis is now owned by staff and the public, and it is hoped that many patients will benefit and it will also change attitudes, behaviours and culture. As leaders we can encourage simple solutions to this complex challenge.
That’s why I think it is probably one of the most revolutionary interventions for frail older people in recent history.
- Useful documents
- Deconditioning awareness campaign by University Hospitals of North Midlands NHS Trust
- Posts by Dr Amit Arora
- Better ageing