Considerations of a Hospitalization Part 3
As we age our immune system becomes less capable of fighting illness, resulting in the need for more support from medical interventions. Older adults experience a reduction in muscle mass, leading to more severe weakness with illness.
Severe weakness itself may result in a hospitalization as the home environment is not meeting the needs of the older adult. Weakness and muscle catabolism as a result of immobility results in a further reduction in muscle mass (catabolism is when the body uses lean muscle as fuel, essentially cannibalizing itself).
The hospital environment
This is the first risk factor for Post Hospitalization Syndrome. Although the body needs rest desperately to recover from illness during hospitalization. The 24 hour routine and constant monitoring results in sleep deprivation and disruption of circadian rhythms. Older adults have weaker cues for sleeping and waking and are more prone to sleep disorders as a demographic group. The data connecting poor sleep to adverse health outcomes is conclusive. Sleep deprivation puts seniors at risk for high blood pressure, high blood sugar, poor cognitive performance, poor physical coordination and delirium. The irony is these new medical problems are increasing the length of stay, number of medications and reduction in mobility, exacerbating the negative effects of hospitalization.
Change in eating habits, NPO status
Many procedures require an empty stomach to avoid the risk of aspiration. While this precaution is necessary, the lack of calories contributes to further weakness when frequent, nutrient dense meals would optimize healing. Delayed or reschedule procedures exacerbate the problem. One study showed one-fifth of hospitalized patients over 65 had intake less than 50% of their daily requirements. Weight loss during hospitalization can be a strong predictor of readmission. Malnutrition has adverse effects on wound healing, pressure ulcers. Untreated malnutrition in the hospital effects every body system.
Pain and discomfort
Studies show more than 50% of older adults admitted to the hospital received pain medication. Untreated pain negatively impacts activity, mood and cognition. Immobility in itself can cause pain, non-medication interventions should be offered first. Ice packs, heating pad, taking a walk or changing positions can reduce pain without introducing a new medication. If a patient has severe pain, an opioid may be introduced. These powerful medication may result in lethargy and confusion in a patient without a tolerance. The residual effects of a new pain medication can span days to weeks. The most common side effects are lethargy, tiredness and confusion. For an older adult needing to have the motivation and strength to work with physical therapy to maintain or regain strength, this is especially detrimental.
