Assessment for incipient hospital-acquired deconditioning in acute hospital settings: A systematic literature review

Abstract

LAY ABSTRACTHospital-acquired deconditioning can occur insidiously and rapidly as a result of enforced bed rest, immobilization or sedentary behaviours. While hospital-acquired deconditioning can occur in people of any age, it is particularly problematic in elderly people, as it can lead to irreversible functional decline. Hospital-acquired deconditioning is preventable with proactive, comprehensive regular assessment to detect changes in the performance of body systems. The time-period of assessment must be short, so that repeated assessments can be made during an acute hospital admission. At present there is no comprehensive, time-sensitive assessment instrument for hospital-acquired deconditioning. Based on a systematic scan of the literature, this paper proposes a core set of items that could be developed into a comprehensive, standardized assessment instrument for regular application by any healthcare provider during an acute inpatient stay, to identify incipient hospital-acquired deconditioning. The assessment items measured anthropometrics, gait, balance, mobility, activities of daily living, and skin integrity.Objectives: To systematically identify literature reporting on assessment instruments relevant for incipient hospital-acquired deconditioning during acute hospital admissions; evaluate their psychometric properties; and identify individual assessment items to form the basis of a comprehensive acute hospital test battery for hospital-acquired deconditioning. Design and data sources: Systematic evidence scan of MEDLINE, CINAHL, PubMed and Google Scholar from database inception to January 2018. Study selection: Papers reporting psychometric properties of assessment instruments to detect change in body function and structure, relevant to hospitalacquired deconditioning were selected. Included instruments should assess one or more elements of hospital-acquired deconditioning, reflect the short time-frame constraints of acute hospital admissions, and be able to be applied by any healthcare provider. Quality evaluation: Evidence of psychometric properties and utility were assessed using a validated instrument. Data extraction: Hospital-acquired deconditioning assessment items. Results: Eight potentially-relevant instruments were identified, with moderate-to-good validity and utility, but limited evidence of reliability. These instruments reported a total of 53 hospital-acquired deconditioning assessment items. Seventeen items with measurement periods greater than 3 days were excluded. The remaining items measured anthropometrics, gait, balance, mobility, activities of daily living, and skin integrity. Conclusion: These assessment items provide the basis of a multifaceted evidence-based test battery to comprehensively and repeatedly assess acute hospital inpatient function for incipient hospital-acquired deconditioning.

Hospital‐associated deconditioning: Not only physical, but also cognitive

“…Our findings suggest that HAD and frailty are intimately related, affecting a similar range of body systems (musculoskeletal, respiratory, urinary), daily functions (sleep cycle, mobility) and cognitive abilities 113 …”

“…112 Our findings suggest that HAD and frailty are intimately related, affecting a similar range of body systems (musculoskeletal, respiratory, urinary), daily functions (sleep cycle, mobility) and cognitive abilities. 113 Possibly due to the multifactorial pathophysiology of HAD, a comprehensive geriatric assessment unit seemed to be more effective than a conventional acute medical hospitalization unit in its prevention. This would suggest the need to implement interdisciplinary working and multidisciplinary geriatric assessment in all hospital departments.…”

“…However, we used a variety of sources and databases from non‐English speaking areas as well. Our review also has the advantage of addressing overall aspects of HAD, whereas existing reviews have generally focused on just one aspect of HAD 113,114 . The aim of this review was to be all‐encompassing, to narratively outline the current evidence and highlight the main research gaps.…”

“…However, we used a variety of sources and databases from non-English speaking areas as Our review also has the advantage of addressing overall aspects of HAD, whereas existing reviews have generally focused on just one aspect of HAD. 113,114 The aim of this review was to be all-encompassing, to narratively outline the current evidence and highlight the main research gaps. As part of a roadmap for clinical practice and future research, we propose that HAD in older people should be screened as a functional decline from pre-admission baseline until at least 1 year after discharge.…”

Letter to the Editor: Selecting the best measure for hospital-acquired deconditioning

“…We note with interest the recent systematic review by Gordon et al (1) regarding assessment instruments to evaluate hospital-acquired deconditioning (HAD). Precipitated by immobility and inactivity during hospitalization, HAD is associated with poor outcomes, such as decreased quality of life and reduced survival (2).…”