Tackling immobility in hospitalized seniors.

through a hospital ward has seen room after room of elderly patients quietly dozing in bed, as if every patient was being treated for a cold or hysteria, or recumbence the necessary condition of all therapies. And doesn’t it make sense, after all, that elderly patients should spend their days on their back? Traditional wisdom dictates that bedrest promotes healing and recovery, much in the manner that “rest in bed and drink plenty of fluids” is the solution to the common cold and an extended bout under the covers was the definitive answer in the 19th century to a diagnosis of hysteria. But it may be time to put the bedrest prescription to bed and get those seniors moving through the wards, as studies indicate that elderly, hospitalized patients are more likely to be discharged to long-term care facilities, or even to die, as a result of the deleterious effects of prolonged bedrest, including “hospitalizationassociated disability,” i.e., the loss of ability to complete one or more of the basic activities needed to live independently, such as bathing, dressing and using the toilet. “Patients often leave the hospital worse than they came in. It really raises questions to me about what we’re doing in the hospital environment,” says Dr. Cynthia Brown, a geriatrician at the University of Alabama at Birmingham and a researcher at the Birmingham /Atlanta Veterans Affairs Geriatric Research, Education and Clinical Center. “We know that bed rest in and of itself is associated with numerous adverse outcomes, many of which we are trying to prevent, like pressure ulcers, deep vein thrombosis and functional decline,” adds Brown, whose studies indicate that an elderly patient typically spends a staggering 83% of the time he is hospitalized lying on his back. Brown and colleagues attached wireless accelerometers to hospitalized seniors and found that they spent just 3% of their time standing or walking (J Am Geriatr Soc 2009;57:1660-5). Indeed, the evidence has long been compelling that prolonged bedrest for a senior is hazardous. Hospitalized seniors lose up to 5% of their muscle strength daily (Ann Intern Med 1993; 118: 21923). Compared with more active and mobile hospitalized counterparts, immobile seniors are six times more likely to be discharged to long-term care facilities and 34.3 times more likely to die in hospital (J Am Geriatr Soc 2004;52:126370). In one study, some 799 of 2279, or 35%, of hospitalized elderly patients were discharged with hospitalizationassociated disability and within a year, 41.3% of those had died and only 30.1% were at baseline function (J Am Geriatr Soc 2008; 12:2171-9). Tackling immobility in hospitalized seniors