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Dr Amit Arora is a Consultant Physician and Geriatrician at University Hospital of North Midlands, Stoke on Trent and an Honorary Clinical Lecturer at Keele University. In this blog he takes a look at the impact deconditioning can have on patients and what can be done to help tackle it.
Many years ago I was subject to restricted mobility following an emergency appendicectomy.
It took me a surprisingly long time to regain my strengths and abilities – I noted that despite the youth and the will, my muscles would not move and it took a while to recover back to normal!
When I relay my own story back to the frail older people I see at work, I can understand why someone who was able to function well before they came to hospital takes longer to regain their pre-admission functionality. Prolonged hospital stay, bed rest and associated risks may lead to loss of muscle power, strength and abilities. This is something we surely need to avoid. It should help achieve a shorter length of stay, better outcomes for patients and better ability at discharge.
Older people, whether in hospitals, care homes or at their own homes, who do not get enough opportunity to mobilise, can have an increased risk of reduced bone mass and muscle strength, reduced mobility, increased dependence, confusion and demotivation. These problems can be attributed to the phenomenon of what can be termed as ‘Deconditioning Syndrome’.
This affects well-being as well as physical function and could result in falls, constipation, incontinence, depression, swallowing problems, pneumonia and leads to demotivation, and general decline. Deconditioning Syndrome can happen in hospitals right from the time of entry, care homes and also patients’ own homes.
Preventing Deconditioning Syndrome requires a broader strategic approach that includes physical therapy, maintenance of nutrition, medical management, and psychological support including addressing loneliness; essentially addressing elements of the Comprehensive Geriatric Assessment.
But, are all health care staff and patients aware of the phenomenon of deconditioning?
Are we doing enough to prevent deconditioning? Our survey demonstrated limited awareness of this important condition. Hence we developed a campaign to educate and make our staff aware about Deconditioning Syndrome.
What can be done? Well simple things first.
We could ensure that glasses and hearing aids are readily available, calendars and clocks are visible to promote awareness, ensure that patients are sat up in chairs, preferably in their own clothes.
We could ensure that meals are eaten whilst sitting in chairs and not spoon fed in bed unless circumstances dictate so.
We could encourage patients to wash and dress independently, walk to the toilet where possible, provide appropriate mobility aids earlier on and encourage patients to keep their arms and legs moving in bed or chair.
We should ask is the chair and mobility aids of the right height; is the urinary catheter still required or can it come out? Removing restrictions on visiting hours and encouraging normal social interactions will also help to maintain functionality, regain independence and reduce loneliness. All this will help with “Home First”.
Patients need to be supported and encouraged to get moving as quickly as possible, where possible. As leaders it is our role to encourage our staff to in-turn encourage our patients to do what they can.
Education of patients, relatives, carers and staff about the dangers of deconditioning is vital, since bed rest continues to be expected during a phase of illness despite the considerable evidence showing potential adverse effects from inactivity. Of course there are times and conditions when bed rest would be advisable; but more often than not, this is not the case in the strictest terms.
Regaining strengths and functionality (re-conditioning) can often take twice as long as deconditioning. If it has taken one month to get to this low level of function, it may take two months of hard work to return to their original level. It is often said that for every 10 days of bed rest in hospital, the equivalent of 10 years of muscle ageing occurs, in people over 80 years old- this may or may not be true to the word but certainly puts things in perspective and makes one think differently- surely did it for me and my colleagues.
If we want the best outcomes for our patients, it is necessary to design and develop effective programs for prevention of deconditioning. Deconditioning can start within hours of immobility. We need to get our patients up as quickly as possible, while being careful not to overload them. Under the guidance of therapists, it can be done by ward based staff- it’s ‘everyone’s business’ to get involved in restoring normalcy.
Across our hospitals and care homes, we need to inculcate a culture to make health care staff and families aware of the phenomenon of deconditioning. We need to develop simple exercise models for our ageing population which should be everyone’s business and not just of therapy staff. This may cost more in the short term, but with major long term societal health gains.
We have launched a ‘Deconditioning Awareness’ campaign’. There are banners, posters, screensavers, information leaflets, exercise programs, videos and demonstrations to raise awareness and some of these can be accessed on the link below and the material contained here is available freely for use for benefit of patients.