Abstract
BackgroundOlder adults, especially those with physical and social complexities are at risk of hospital-associated deconditioning. Hospital-associated deconditioning is linked to increased length of stay in hospital, stress, and readmission rates. To date, there is a paucity of research on the experiences and implications of deconditioning in hospital from different perspectives. Therefore, the objectives of this exploratory, descriptive qualitative study were to explore hospital-associated deconditioning from the views of different stakeholders and to develop an understanding of deconditioning from physical, social, and cognitive perspectives.MethodsBetween August 2018 and July 2019, in-depth, semi-structured interviews were conducted with patients 50 years or older, who had a hip fracture or delay in discharge, as well as caregivers, providers, and decision-makers who provided support or impacted care processes for these patients. Participants were recruited from one urban and one rural health region located in Ontario, Canada. All interviews were audio-recorded, transcribed, and analyzed using a constant comparison approach.ResultsA total of 80 individuals participated in this study. Participants described insufficient activities in hospital leading to boredom and mental and physical deconditioning. Patients were frustrated with experiencing deconditioning and their decline in function seemed to impact their sense of self and identity. Deconditioning had substantive impacts on patients’ ability to leave hospital to their next point of care. Providers and decision-makers understood the potential for deconditioning but felt constrained by factors beyond their control. Factors that appeared to impact deconditioning included the hospital’s built environment and social capital resources (e.g., family, roommates, volunteers, staff).ConclusionsParticipants described a substantial lack of physical, cognitive, and social activities, which led to deconditioning. Recommendations to address deconditioning include: (1) measuring physical/psychological function and well-being throughout hospitalization; (2) redesigning hospital environments (e.g., create social spaces); and (3) increasing access to rehabilitation during acute hospital stays, while patients wait for the next point-of-care.
Highlights
Older adults, especially those with physical and social complexities are at risk of hospital-associated deconditioning
Preventable harm includes hospital-associated deconditioning (HAD) [8], known as post-hospital syndrome or the trauma of hospitalization [9, 10], which is characterized as a period of generalized risk and stress occurring while a patient is receiving care in hospital from an acute condition [9, 10]
A high stress hospital environment has been shown to contribute to HAD due to sleep disturbances, poor nutrition, limited mobility, and overall uncertainty experienced by patients [8,9,10, 12]
Summary
Especially those with physical and social complexities are at risk of hospital-associated deconditioning. HAD has been associated with overall longer lengths of stay in hospital [11], increasing periods of generalized risk and stress [9, 10], and higher rates of readmission [9, 10, 12]. A systematic review of hospital-based interventions targeted at reducing HAD found that while enhanced care programs may be beneficial for certain outcomes (ability to perform activities of daily living), overall, there was lowquality evidence for the risk of physical performance decline, mobility at discharge, readmission rates, length of stay, and mortality at 3 and 12 months when comparing enhanced care programs to usual care [18]. Despite some research on factors impacting HAD and interventions to limit it, there has been little focus on the experiences of deconditioning in hospital from patient, caregiver, and provider perspectives. Given the potential negative impacts of HAD and the limited understanding of individuals’ experiences, our objective was to fill two key gaps in the literature: (1) to explore HAD and transitions in care from multiple stakeholder perspectives and (2) to understand HAD from a physical health standpoint, but social and cognitive perspectives as well
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