Reducing “iatrogenic disability” in the hospitalized frail elderly

Abstract

1- "Iatrogenic disability" was defined by the task force as the avoidable dependence which often occurs during the course of care. It involves three components that interact and have a cumulative effect: a) the patient's pre-existing frailty, b) the severity of the disorder that led to the patient's admission, and lastly c) the hospital structure and the process of care. 2- The prevention of "iatrogenic disability" involves successive stages. - becoming aware that hospitalization may induce dependence. Epidemiological studies have identified at-risk populations by the use of composite scores (HARP, ISAR, SHERPA, COMPRI, etc). - considering that functional decline is not a fatality. Quality references have already been defined. Interventions to prevent dependence in targeted populations have been set up: simple geriatric consultation teams, single-factor interventions (aimed for example at mobility, delirium, iatrogenic disorders) or multidomain interventions (such as GEM and ACE units, HELP, Fast Track, NICHE). These interventions are essentially centered on the patient's frailty and have limited results, as they take little account of the way the institution functions, which is not aimed at prevention of functional decline. The process of care reveals shortcomings: lack of geriatric knowledge, inadequate evaluation and management of functional status. The group suggests that interventions must not only identify at-risk patients so that they may benefit from specialized management, but they must also target the hospital structure and the process of care. This requires a graded "quality approach" and rethinking of the organization of the hospital around the elderly person.

Tradução e adaptação transcultural do Hospitalized Elderly Needs Awareness Scale (Henas) para a língua portu- guesa (Brasil e Portugal)

“…As necessidades do idoso hospitalizado em termos de mobilidade tornam-se fulcrais em muitos aspetos relacionados com as habilidades e a capacitação necessárias para manter autonomia na realização dos autocuidados e, entre outras complicações, prevenir o DF (3,8).…”

“…Num estudo realizado em contexto hospitalar, os autores (8) reportaram que 65 % dos pacientes idosos admitidos apresentavam sinais de descondicionamento após dois dias de internamento. Entre o segundo dia de internação e a alta clínica, 67 % deles não conseguiam melhorar, e em mais de 10 % das situações ocorreram agravamento da situação.…”

The most important considerations in the assessment of functional decline in seniors: a literature review

“…Additionally, 3 months after discharge, seniors who had used a mobility device before hospitalization were more likely to experience functional decline in both ADL and IADL statuses [38].Other factors that may contribute to the development of functional decline in hospitalized seniors include pre-admission physical, social and cognitive statuses of the patient [39], comorbidity and polymedication [40], having had a hospitalization or emergency visit during the last 12 months [41], and iatrogenic conditions. Iatrogenic disability is defined as "avoidable dependence which often occurs during the course of care" [42].…”

Repérer et prendre en charge les personnes âgées en pratique clinique : nous ne devons plus attendre

“…Des interventions multidomaines ou multimodales seront à envisager. De plus, des actions devront être mises en oeuvre pour prévenir la dépendance iatrogène si ces sujets âgés fragiles sont amenés à être hospitalisés [13]. Cette ouverture de la médecine gériatrique vers l'évaluation de la préfragilité et la fragilité sera coût-efficiente et peut offrir un nouveau rebond pour la discipline, comme cela est suggéré dans les récentes initiatives européennes [14,15].…”