Evidence based information on hospital acquired deconditioning in older adults, links to any studies referenced are included in the notes section of the presentation slides.

1. Hospital Acquired
Deconditioning in
Older Adults
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2. Overview
• Ageing population
• Deconditioning research
• Importance of muscle mass and strength in
older adult rehab
• Latest research / public health agendas
• What we can do about it

3. Ageing Population
• Over 65’s are the most rapidly
expanding population demographic
• 40% of total NHS expenditure
CURRENTLY spent on over 65’s
• At substantial risk of the age related
conditions osteoporosis, sarcopenia
and physical frailty
• Increased risk of falls and fractures
• Increased need of healthcare support
for ADL’s & increased healthcare
costs.
• Increased risk of multi-morbidity &
mortality.

4. Strength levels through the lifespan
• Increased muscular strength is
associated with higher levels of
physical function and lower risk of all
cause mortality throughout the
lifespan
• 50% of the physical decline associated
with ageing is actually disuse atrophy
from prolonged physical inactivity
• As strength reduces into the ‘disability
threshold’ independence in mobility
and ADL’s is limited
• Muscular weakness & osteoporosis
estimated to have an annual health
care cost of over £10 billion in the UK

5. Effect of Muscle Mass on Health

6. Muscular strength key research

7. - Decrease in muscle strength, size and
physical performance
- Associated with increased risk of functional
impairment, poor health-related quality of
life & premature death.
- Increased need of healthcare support for
ADL’s & increased healthcare costs.
- Longer length of stay and increased risk of
hospital acquired infections
£2707 more for sarcopenic patient
Annual total cost = £2.5 billion
(Pinedo-villanueva et al 2018)
Sarcopenia

8. Sarcopenia & Older Adults
Patients under these thresholds
should be seen as a serious cause for
concern;
Increased risk of multi-
morbidity & mortality.
Limited physical performance,
reduced independence & reduced
quality of life.
Increased need of healthcare
support for ADL’s & increased
healthcare costs.
Strength
Assessment
Grip Strength 5 Sit to Stands
M < 27kg
F < 16kg
> 15 seconds
Increased risk of falls and
fractures.

9. Sarcopenia Clinical Guidelines

10. Osteosarcopenia

11. Deconditioning

12. Key Deconditioning Research

13. Categorising Deconditioning
 Sarcopenia- age related loss of muscle mass, strength and physical function
 Disuse Atrophy – loss of muscle mass & strength from inactivity and mechanical
unloading
 Cachexia - muscle wasting condition with inflammatory & malnutrition component
accompanying diseases such as cancer, COPD, renal disease
 Frailty - a syndrome resulting from age-related cumulative declines of multiple
physical & psychosocial factors that results in reduced resilience to stressors
All are amplified by events that alter pre-existing mobility levels and by certain medications.
For these reasons deconditioning is often accelerated in the hospital environment.

14. Hospital Admission Accelerates
Deconditioning

15. Bed Rest in Older Adults

16. Vicious Cycle of Deconditioning

17. Bed Rest & Muscle Loss
- Mixed findings on rate of strength
and muscle mass loss. It reduces
quickly but depends on a variety of
factors, no fixed rate of loss.
- Much more rapid decline in lower
limb than upper limb, which effects
mobility & transfers
- Older adults who have a lower
reserve of strength are more likely to
lose independence after a period of
hospitalisation / bed rest

18. Hospital Acquired Disability
- Research has consistently shown that
older adults who could mobilise
independently prior to hospital admission
increase their overall sitting time and
reduce physical activity levels while in
hospital
- During an acute hospitalisation, older
adults spend approximately 83% of their
hospital stay in bed and 12% of their time
in a chair, therefore accelerating reductions
in muscle mass and strength (Falvey et al,
2015).
- When hospitalised for over 1 month older
adults are 61 times more likely to develop
disability in ADLs than those who are not
hospitalised (Gill et al, 2004).

19. Other Effects of Deconditioning
Deconditioning can lead to;
• Cardiorespiratory decline
• Postural hypotension
• Increase risk of further chronic illness
• Reduction in balance & proprioception
= falls risk
• Poor skin integrity, pressure sores
• Incontinence
• Psychosocial issues
• ‘Treat people like they are frail,
and avoid activity, and they become
more frail at an even faster rate’

20. Sarcopenia & Frailty Overlap
- Sarcopenia and frailty are both a
consequence and cause of chronic
disease and the effects are often
amplified in advanced age
- Progression of these processes reduces
physiological reserves of multiple body
systems and limits full recovery from
adverse health events
- Linked to a progressive deterioration in
physical and cognitive function
- Associated with a loss of independence
and increased likelihood of disability,
hospitalisation and institutionalisation

21. Frailty – Progressive Decline

22. Frailty International Guidelines

23. What we can do about it

24. Exercise for Frail Older Adults
‘Taking into consideration the current evidence about the
benefits of exercise in frail older adults, it is unethical to not
prescribe physical exercise to these individuals, because not
doing so means doing harm by withholding indicated and
effective treatment’
Dr Gustavo Duque and Dr John Morley
Professors of Geriatric Medicine

25. Elderly Exercise Programmes in Hospital
Participants: 370 patients average
age 87 years.
Intervention: Control group received
standard hospital rehab.
Intervention group performed 2 daily
moderate resistance, balance &
walking sessions.
Outcome: Improved cognitive and
mood status, quality of life & grip
strength. Reduced length of stay ,falls
and readmission rate and mortality
at 3 months after discharge.
Participants: 268 patients, average
age 88 years
Intervention: Both groups received
standard hospital care.
Intervention group performed an
extra 20 mins per day 3 sets max sit
to stands, 3 sets max walking
distance.
Outcome: Greater loss of the ability
to perform one or more basic
activities of daily living in the control
group.

26. Older Adult Exercise Programmes

27. Walking Speed is a Vital Sign
Walking speed is an an
accurate predictor of;
• Future health status
• Functional decline
• Falls risk
• Hospitalisation
• Discharge location
• Mortality

28. Step Count Milestones & Effects on Health

29. Increased Emphasis on Strength Training

30. Exercise Can Prevent Functional
Decline in Hospital

31. Moving More in Hospital
More Stands More Steps
More Exercise

32. Deconditioning Information Sheets

33. Implementation on the wards
Increased rehab input reduces effects of deconditioning and
can help maintain functional independence
Practical suggestions;
- Flag up if a patient hasn’t transferred out of bed in the last
48 hours
- Provide deconditioning information sheets to patients &
families
- Sit out in chair or sit up in cardiac chair position at meal
times
- Break up prolonged periods of inactivity
- Encourage multiple stands when using stand aid if feasible
- Encourage regular walking if appropriate as hospital
environment will restrict their normal daily step count, walk
to toilet rather than use bottles etc
- Progress through John Hopkins mobility progressions and
perform John Hopkins deconditioning exercise sheets

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see how we put all these methods into
practice!
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