By Dr. Kate Gregorevic, May 28th 2016
Hospitalisation is a sentinel event for older adults. Being admitted to hospital, especially if unplanned for an illness like pneumonia, is very scary. Sometimes the illness can even be life threatening. The majority of people will leave hospital, but for those aged 75 and older around 30-40% will experience functional decline. This is a particular risk for those who are already frail. As a doctor working in the hospital setting, it is heartbreaking to explain this loss of independence to patients and their loved ones. Appropriate medical, nursing and allied health care is critical, but it is not just up to the staff. There are things that you and your family can do to not only survive but make a full recovery following your illness.
Frail older adults are at higher risk for adverse outcomes than others. Frailty is a loss of physiological reserve leading to an individual being at risk of new disability. As people become more frail, they often need more help doing day to day tasks, may experience falls and may even begin loosing weight. People who have cognitive impairment or dementia are also at increased risk. If you think that this applies to you or your loved one, it is important you let hospital staff know.
It is surprisingly easy to become malnourished in hospital. When people are sick, they often don’t have much appetite. Although some hospitals have invested in improving food quality, many hospitals still serve food, which is unfamiliar and unappetising. If you are having surgery or another test you may have to fast. Even in this short time period, inadequate food intake can increase loss of muscle. Protein intake is particularly important. If you are finding that you don't have much of an appetite, it is important to focus on high protein, high kilojoule foods, like full fat yoghurt and milk with sustagen. Ask your family to bring in some favourite meals. There will be a dietician available to help guide these choices, particularly if you have a medical condition like diabetes. If you have been asked to fast, always ask why and find out when you will be able to eat again. By taking these steps to maintain nutrition, you are more likely to recover faster and leave hospital sooner.
When you are unwell, it is hard to contemplate getting out of bed and walking, but this is critical for recovery. There are often restrictions on walking in hospital to minimise the risks of falls. The physiotherapist is the best person on the team to discuss safe mobility. With some guidance from the physiotherapist, it is important that you mobilise as much as you can. Even just sitting out of bed will enable you to breath more deeply and ward off the dreaded pneumonia. Basically the more you walk in hospital, the faster you will walk out!
Doctors and nurses are very bad at recognising when they are using medical jargon. They spend so much time working and socialising with other medical people that they just don't realise they are using technical language. Many people are intimidated by the hospital environment and fear that asking for explanations will make them look silly, but it is actually the responsibility of the healthcare professionals to explain things in terms everyone can understand. If you don’t understand your illness or your treatments, keep asking questions until you do. The better you understand what’s happening to you, the better you can take an active role in managing your recovery.
HAVE THE DIFFICULT CONVERSATIONS
No one likes to think about the worst things happening when they become unwell and are admitted for hospital, but an illness is often a time of great reflection. We are now seeing an increasing awareness of advanced care planning in the community, and this means recording your wishes and values regarding healthcare and quality of life so that if you are not able to make decisions regarding your medical treatment, other people can still act according to what you would want. If you feel that for quality of life, there are certain things that are important to you, like not being kept alive in a vegetative state or completely dependent for all care, make sure those you love know this, to give you peace of mind.
FOR FRIENDS & FAMILY
What if it’s not you, but your loved one who is admitted to hospital? There are key things that only family can do to aid recovery.
Watch out for delirium
Frail older adults are particularly vulnerable in the hospital environment. Around 30-40% of older adults will experience delirium. Delirium is a sudden onset of confusion and a change in alertness. The confusion can fluctuate throughout the day. This can happen before or during the hospital stay. Some people will be more agitated some will be more sleepy. The biggest risk factor for delirium is pre-existing impaired cognition, particularly dementia.
Delirium can be difficult to identify and diagnose. Patients may describe odd stories, like policemen coming into the room in the middle of the night, little children running around or insects. They may seem to pluck at the air, or drift off in the middle of a conversation. The type of delirium most likely to go unnoticed is hypoactive delirium, where someone becomes very sleepy. Medical staff need to be on high alert for any of these symptoms, but often it is the patient’s family and friends who are first to notice that the person they love is not their usual self.
It is very hard to see someone you love struggling with an illness. Admission to hospital is incredibly stressful for the patient and their loved ones. For a frail older person who is feeling sick and stressed, it can be very difficult to speak up if they have concerns. The friends and relatives will often be the first to notice something is not right. If your loved one seems weaker than prior to hospital, more confused or you’re just not sure they are getting better, speak up.
It is impossible to overstate how important friends and family are to recovery. With so much focus on the physical aspects of illness, it is easy to forget the importance of emotional support– just visiting, bringing some favourite foods and sharing some time with your loved one, may be enough to help them walk back out of hospital.
We as health professionals have a long way to go to make hospitals a better environment for older adults. The good news is that there is increasing recognition within hospitals of the importance of providing specialised care to older adults, and steps are being taken to improve processes and environment. It is quite disempowering to be dressed in a hospital gown, feeling unwell in a hospital bed and not really understanding what is going on, but you are not a passive agent in your recovery. By taking to steps to maintain nutrition, mobility and asking lots of questions, you can take back some control and take an active part in your recovery.