What is Post-Hospital Syndrome?
If you’ve ever been hospitalized for any length of time, you’ve experienced a major disruption in your daily routine. Most of us can snap back into our routines with little difficulty once we are discharged from the hospital. However, the older the patient, the more difficult it is to resume the activities of daily living.
According to The Journal of Hospital Medicine, discharge marks the start of a 60- to 90-day period of increased vulnerability to a range of other health problems, stemming from the stress of hospitalization itself. There is an elevated risk for hospital readmission and death. In 2016, about 18 percent of discharged Medicare beneficiaries returned to the hospital within 30 days. The term post-hospital syndrome (PHS) has been used to describe this time of enhanced vulnerability.
The Cause of Post-Hospital Syndrome
Yale cardiologist and healthcare researcher Dr. Harlan Krumholz notes that most hospital patients:
- are commonly deprived of sleep
- experience disruption of normal circadian rhythms
- are nourished poorly
- have pain and discomfort
- confront a baffling array of mentally challenging situations
- receive medications that can alter cognition and physical function
- become de-conditioned by bed rest or inactivity
Furthermore, he found that one fifth of hospitalized patients 65 years of age or older had an average nutrient intake of less than 50% of their recommended maintenance requirements.
And patients are commonly ordered to have nothing by mouth for specified periods, during which they are not fed by any alternative means. Cancellations and rescheduling of procedures or tests can extend these long periods of time.
Malnutrition can affect every system in the body, resulting in the following risks:
- impairment of wound healing
- increased risk of infections and pressure ulcers
- decreased respiratory and cardiac function
- poorer outcomes of chronic diseases
- increased risk of cardiovascular and gastrointestinal disorders
- poorer physical function
According to surveys of hospitalized patients, sources of emotional stress include social isolation; loss of autonomy and privacy; fear of serious illness; lack of control over activities of daily living; and death of a patient roommate. Hospitalized patients often meet a variety of health care professionals but have little time to learn their names or understand their roles. Schedules are often unpredictable, and in patients who are already under stress, information overload can be stressful and may even provoke confusion. Moreover, these stressors of hospitalization can cause delirium, which is associated with increased risk after discharge.
How Can We Minimize PHS?
Families can bring in favorite foods and help their relatives eat. They can ensure that patients have their hearing aids, dentures, eyeglasses, and walkers or canes to help them stay oriented and mobile.
With a physician’s O.K., they can accompany relatives on short strolls down the corridor to ward off deconditioning, and ask about curtailing wee-hour tests and readings.
Families must be present at discharge planning meetings and be very clear about follow up care. Information overload is bound to confuse the patient, so it is imperative to have family support at any meetings pertaining to discharge plans, At the very least, a detailed schedule of follow-up appointments, medication, prescription frequencies and progress expectations is a must. The frail elderly will need their family or caregiver to help them adhere to the treatment plan until the patient is stable. Remember to acquire written materials in a language appropriate to the patient.
For more information about PHS refer to the following links:
https://www.nytimes.com/2018/08/03/health/post-hospital-syndrome-elderly.html
https://www.nejm.org/doi/full/10.1056/nejmp1212324
https://myheartsisters.org/2018/04/22/post-hospital-syndrome-dr-harlan-krumholz/