Cascade of Dependency (AKA HOSPITAL ACQUIRED FRAILTY)

So just how fast does the Cascade of Dependency (AKA HOSPITAL ACQUIRED FRAILTY) happen?

Changes begin virtually overnight, and the stampede of systemic attacks on our bodies quickens.

Physical therapy is not just for post-operative care for, joint surgery, such as hip or knee replacement. It is a vital component for recovery from heart surgery, neurosurgery, or chronic medical conditions requiring hospitalization for several days.

UTIs, cognitive decline (no this isn't dementia), muscle wasting, pulmonary challenges, BP changes, etc., etc.

We've all seen this happen with older patients. Sometimes, they hit home a lot harder.

Here is a tragic story.

A grandmother who was VERY clearly mobile healthy, and smart as a whip 2 weeks before her hospitalization.

In 2024, we realize how detrimental bed immobility is.

For the first week in the hospital following a fall and surgery, she was to get PT 2x per day. 14 treatments ordered.

How many did she actually get? 2 times...TOTAL.

Never out of bed, never sitting up at bedside, she just laid in bed while her whole body shut down.

But she was seen by a number of 'specialists' as multiple systems were failing. Awesome, but they missed the root cause.

The family requested repeatedly therapy and even nursing help to get her out of bed. Didn't happen.

Can we at least get her sitting up for meals? Didn't happen.

I should have flown out there to help. I didn't. I trusted the hospital would keep its promises to finally start getting her up. And then it was too late.

We finally got her into skilled nursing with the help of the orthopedist. I called ahead to give them the details and to ensure they got her moving and kept an eye on her--with her cognition now she may be impulsive and try to get up.

She did try to get up (even in her state, she didn't want to be stuck in the bed) and fell all over again. Back to the hospital and back to being confined in bed.

My family lost her in 3 short weeks. Several months later the emotions for many of us are still raw.

For many older persons, hospitalization results in functional decline despite a cure or repair of the condition for which they were admitted. Hospitalization can result in complications unrelated to the problem that caused admission or to its specific treatment for reasons that are explainable and avoidable.

BOTTOM LINE

IF AT ALL POSSIBLE HAVE A FAMILY MEMBER OR CLOSE FRIEND VISIT YOUR RELATIVE TO HELP THEM SIT UP AND/OR GET OUT OF BED DAILY IF POSSIBLE.

I'm Dr. Gary Levin, a retired ophthalmologist who has dealt with many geriatric patients.