Friday, April 15, 2011

What Do Elderly Patients And Astronauts Have In Common?

Today's post is a guest essay written by a distinguished physician, Dr. Harold Rodner, a doctor of Internal Medicine, with a sub-specialty in geriatric medicine. He has an active clinical practice in Southeastern Michigan, and is an outspoken advocate of quality health care for the elderly.

Here is Dr. Rodner's essay—

"What does my 92 year old mother-in-law share with an astronaut? They both have had a gravity free experience, the astronaut in space, my mother-in-law in a hospital bed.

"The deconditioning that occurs in space also occurs in a hospitalized patient. On earth, we are constantly exposed to the mechanical stress of gravity when we are up and about. In space or in bed this effect is reduced or lost. As a result, muscle and bone mass is diminished. For the elderly patient this is added to the loss that occurs with aging. Inactivity also decreases flexibility which an older patient can least afford. Bed rest increases the risk of pneumonia, blood clots to the legs and lungs and bed sore.

"In space, sensory disorientation can occur during the first few days. In the elderly who are prone to developing delirium this is a concern. Prolonged bed rest can be a contributing factor for an extended hospitalization and increases the chance of being discharged to a rehab unit in a nursing home. To quote an associate, “One day in bed, two days in rehab.” As a former Medical Director of a nursing home, I saw this first hand.

"In many hospitals, the dedicated nursing staff is over worked and understaffed. As a result, mobilizing a patient is a time consuming event and not a top priority. According to Dr. Angela Gillis writing in the The Journal of Continuing Education in Nursing in 2008, “ Today’s nurse lacks gerentological preparation in deconditioning prevention and are unable to understand and meet the needs of older adults entrusted to their care.”

"Recently, an eighty year old patient’s wife described her experience in the hospital. She said “She didn’t want him to lose what he had.” She requested that the staff walk him. Their response was ” They would do it when they had time.” She then described to me a positive experience she had during a prior hospitalization at another hospital. Therapists dedicated to walking patients assisted in his ambulation.

"Physicians are so preoccupied with the complexity of their patient’s needs they quite often forget to mobilize them or aggressively enforce their order for increased activity. They are not alone in not fully appreciating the risks of bed rest. I reviewed the index of the geriatric review syllabus I used to prepare for my geriatric recertification in 2008. There is no reference to risks of bed rest in the elderly. The syllabus was published by the American Geriatrics Society.

"With all this in mind, I went into high gear with my mother-in-law’s admission for pneumonia. I had the hospitalist write an activity order, “Ambulate in the hall daily with assistance.” I requested a physical therapy consult, hoping that this would lessen the burden on the nursing staff. I also enlisted members of the family to walk her. After six days she was discharged to her senior citizen apartment at her baseline activity level.

"Many things are beyond the control of a family when a loved one is admitted to the hospital. Avoiding deconditioning is one area where they can be proactive. Finally, think of the additional cost to the health care system that could be avoided if the professional care givers were proactive."

That ends Dr. Rodner's essay. If you enjoyed reading it, please feel free to post your comments.

Bob Tell
Author, "Dementia-Diary, A Caregiver's Journal"