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Providing Healthful Post-Hospital Care for Seniors

Hospitalization is a risky, yet often unavoidable business for the elderly.

Nearly one-fifth of seniors are re-hospitalized within 30 days of being discharged, according to data collected on millions of Medicare beneficiaries.

These repeat customers typically return with health issues that differ dramatically from those that landed them in the hospital to begin with. A person suffering from heart failure may be re-admitted the following month with an acute infection, unrelated to the treatment they underwent for their cardiac issues.

"Doctors tend to focus on the specific problems that bring a person into the hospital—not about what happens after," says Harlan Krumholz, M.D., professor of medicine and public health at Yale School of Medicine.

It makes sense. Doctors, particularly those treating patients in the hospital, are charged with handling a specific ailment and sending a person home as soon as possible, hopefully in better shape than when they were admitted.

Yet, mounting evidence indicates that what happens after a person's discharge papers have been signed may be just as important as the care they received while in the hospital.

In a recently-published article in the New England Journal of Medicine, Krumholz explains his theory of a "post-hospital syndrome," a period of frailty and increased risk for illness and re-hospitalization experienced by recently discharged people.

What causes post-hospital problems in seniors?

Krumholz proposes that seniors—who are typically frailer and more wedded to their routines—may be more susceptible to post-hospital syndrome.

He emphasizes that more research needs to be done to flesh out his theory, but says that these factors can make an elder more prone to developing health complications that land them back in the hospital.

During the normal course of hospital care, a person is exposed to a variety of things that can have a negative impact on their health including: sleep deprivation, disruptions of their normal schedule, malnutrition, deconditioning (declines in physical ability brought on by forced bed rest) and medications that mess with their mental and physical functioning.

"The cumulative impact of all these stressors can take a toll on pretty much every system in the body; immune, neurological, etc.," Krumholz says. "When peoples' routines get disrupted, even slightly they become foggy—they aren't themselves. This increases their risk for developing a complication."

He compares the fuzzy feeling of post-hospitalization malaise to the feeling that otherwise healthy people sometimes get during a Daylight Savings times, or the experience of jet-lag after a long flight on an airplane.

Tips for providing healthful post-hospital care for seniors

Preventing post-hospital syndrome in seniors requires a two-pronged approach involving both hospital staff and caregivers.

Krumholz offers a few tips for keeping a senior safe and healthy after a hospitalization:

  • Re-build reserves: The main thing you can do to help your recovering loved one is to make sure they are getting adequate amounts of food, rest and relaxation. This is the best way to revitalize and strengthen their immune system. It's also important not to forget about the role of physical activity in the recovery process. Deconditioning from forced bed rest is common in recently hospitalized people, and can contribute to a host of health problems. Try to get your loved one moving, even if it's just walking down the hallway or up and down the stairs a couple of times.
  • Be aware of the risk: Being aware that your loved one may be more prone to developing health complications following a hospitalization will ensure that you remain vigilant. "Once a senior comes home, it's vital for caregivers to recognize that the period of convalescence can be dangerous," says Krumholz. Keep your eyes peeled for potential health problems, even if they seem unrelated to your loved one's recent hospitalization.
  • Ease back into activities: Depending on their cognitive abilities, your loved one may or may not be aware of the effect that hospitalization has had on them. They probably feel weaker or more disoriented. However, they may not know how their ability to do the things they used to do before being hospitalized has been compromised. "Let them get their bearings back before engaging in activities such as driving," Krumholz advises. If your loved one is capable of understanding, try explaining the importance of getting back into the groove gradually.
  • Re-infuse routine into their life: Hospitalization leads to inevitable disruptions to a person's daily routine. Depending on how long their stay was, a senior may have become somewhat acclimated to the rhythm of life as a hospital patient. When making the switch back to life at home, be sure to take things slow. For example, if your loved one was used to having dinner at 5:30 pm in the hospital, don't immediately start preparing their nightly meal at 7:00 pm. Instead, start gradually serving them dinner ten or 15 minutes later every day until you reach that 7:00 goal.
  • Stay away from sick people: The compromised immune system of a senior just returning home from the hospital may not be strong enough even to combat the common cold. Krumholz suggests keeping recently-discharged seniors away from small children and outings where they would be exposed to large numbers of people (and their attendant germs).
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