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Harvard Reviews of Health News - March 12, 2012
Fighting Frailty Among Elderly in Hospitals

Fighting Frailty Among Elderly in Hospitals

Some hospitals are trying to prevent a common problem among older patients -- they are frailer after a hospital stay than they were before. The Associated Press (AP) wrote about this March 9. Experts told AP that hospital care has focused only on illness or surgery. Less attention has been given to preventing weakness that can occur from being away from regular activities. Staying in bed can increase the risk of infection and slow recovery. It also can lead to rapid loss of muscle strength. AP profiled two hospitals that try to preserve older patients' strength. At Northwest Community Hospital, in a Chicago suburb, older patients are encouraged to walk every day. Volunteers walk with them. Highlands Hospital, in Birmingham, Ala., uses volunteers at mealtimes. They remove plastic wrap that may not yield to arthritic hands. They also chat with patients, in hopes that the company will make them feel like eating. Both hospitals are trying to find out if these programs help people stay in better condition.

What Is the Doctor's Reaction?

Most people who stay in the hospital for more than a couple of days go home weaker than when they came in. If you had surgery or needed treatment for a medical problem, your body used energy to help you heal. Spending long periods of time in bed also keeps your muscles from getting their daily work. They start to lose strength quickly. Doctors call this "deconditioning."

For many older people, deconditioning adds to the dangers of a hospital stay. Seniors who are already frail, or close to it, can't afford to lose any energy. Even a short hospital stay may be the tipping point from being able to function at home to needing a nursing home. Or it may lead to other medical problems that are severe and can't be reversed.

Anyone can recognize frailty when a person is very thin, can't get up out of a chair and shuffles along with a walker. But frailty sets in well before it gets this bad.

However, there is no standard way to define frailty. Features of frailty include:

  • A general decline in physical function

  • Increased risk of sickness and death

  • A reduced ability to fight off sickness and return to health

In the hospital, care is mostly focused on successful surgery or the right diagnosis and best treatment.

Getting the right nutrition and enough exercise during a hospital stay is a major challenge. Often patients cannot eat as they prepare for tests. Or they have a poor appetite that is related to the reason they are in the hospital.

Nurses and physical therapists try to have patients get out of bed as much as possible. This usually means sitting in a chair, with an occasional short walk. Usually the pace is a very slow stroll. Hospital units were never designed with exercise in mind.

What Changes Can I Make Now?

It's good news that some hospitals are taking steps to make it easier for patients to exercise more and boost their calorie intake. However, many patients will arrive too frail to take advantage of these efforts. Avoiding frailty must begin long before any unexpected hospital stays.

To help prevent frailty before a serious illness or hospital stay:

  • Choose a variety of healthy foods. If you are on a special diet, your doctor may loosen up his diet advice to be sure you get enough calories and proteins. Tell your doctor what foods you would like to eat. And don't skip meals.

  • Consider a high-calorie supplement drink. A can or two per day may be all you need.

  • Stay active. Exercise training decreases the risk of frailty even in the very old.

There is no "best" exercise routine. Any activity you enjoy can help you maintain muscle strength. For example, regular walks offer proven benefits. Start slowly, perhaps with a 10-minute walk. After a week or two, add five minutes to each walk, or add another walking day each week.

What Can I Expect Looking to the Future?

Doctors have known about the problem of hospital-related deconditioning for a long time. We have made progress, getting patients out of bed quickly even after major surgery. For some people, getting more exercise and better nutrition in the hospital is easy. But for many who are already frail or disabled, we will need to find some new ideas.

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