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

Abstract

Introduction: Hospital-associated deconditioning (HAD) or post-hospital syndrome is well recognized as reduced functional performance after an acute hospitalization.Recommendations for the management of HAD are still lacking, partly due to a poor understanding of the underlying processes. We aimed to review existing data on risk factors, pathophysiology, measurement tools, and potential interventions. Materials and methods:We conducted a systematic review from bibliographical databases in English, Spanish and French with keywords such as 'post-hospitalization syndrome' or 'deconditioning'. We selected studies that included people aged 60 years or older. Three researchers independently selected articles and assessed their quality. Results: From 4421 articles initially retrieved, we included 94 studies. Most were related to risk factors, trajectories and measures, and focused on the physical aspects of deconditioning. Risk factors for HAD included age, nutritional status, mobility, and pre-admission functional status, but also cognitive impairment and depression. Regarding interventions, almost all studies were devoted to physical rehabilitation and environmental modifications. Only one study focused on cognitive stimulation. Discussion: In the last decade, studies on HAD have mostly focused on the physical domain. However, neurological changes may also play a role in the pathophysiology of HAD. Beyond physical interventions, cognitive rehabilitation and neurological interventions should also be evaluated to improve deconditioning prevention and treatment in the hospital setting.

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“…Longer hospitalization is associated with physical and cognitive deconditioning, as well as longer recovery time after discharge. 27 In our study, neither age, frailty status, nor disease severity were risk factors for long-COVID-19. Although we report a similar median age compared to most published studies, 10,16,22 our results should be carefully interpreted since we have not included severely disabled, and hence frailer patients.…”

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“…Not only are hospital admissions costly, they can also be detrimental to the patient. Patients in hospital are at risk of venous thromboembolism, falls, physical and cognitive deconditioning and contraction of nosocomial infections [13][14][15][16] . In addition, during the covid-19 pandemic, admissions to hospital increased patient risk of contracting covid-19.…”

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“…Globally, 30% of older adults admitted as inpatients report HAD 23 . Whilst, cost-burden data is not reported within the UK, $53.5 billion (8.3% of healthcare spending) was spent in 2019 in the US on HAD 6 . These arguments underscore the importance of interventions which prevention deconditioning and promote reconditioning 6 8 12-15 18 .…”

“…Understanding a system can provide researchers, stakeholders, and policymakers insight into where to leverage change (e.g., change a behaviour) and provide a foundation for the process evaluation of how 'interventions' (i.e., events within the system) can contribute to changes in health outcomes 36 . However, despite their application within public health [33][34][35] , these approaches are to be seldom adopted or applied to HAD 6 .…”