Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 306

Functional decline, defined as a decrement in physical and/or cognitive functioning that leads to a reduced ability to perform the activities of daily living (ADLs) that are necessary to live independently, is a common outcome for older people in the hospital, regardless of whether any adverse events or geriatric syndromes occur during their hospital stay. The dangers of believing the misconception that bed rest is good for hospitalized patients was succinctly put by Asher in 1947:³¹

It is always assumed that the first thing in any illness is to put the patient to bed. Hospital accommodation is always numbered in beds. Illness is measured by the length of time in bed. Doctors are assessed by their bedside manner. Bed is not ordered like a pill or a purge, but is assumed as the basis of all treatment. Yet we should think twice before ordering our patients to bed and realize that beneath the comfort of the blankets there lurks a host of formidable dangers …. Teach us to live that we may dread unnecessary time in bed. Get people up and we may save our patients from an early grave.

Unfortunately, older patients are still often confined to bed more than is necessary, and functional decline remains an extremely common problem in more modern times; in one study, one‐third of elderly patients had lost at least one ADL by the time they left the hospital.³²

Functional decline that occurs during hospitalization can impact the older person (and the healthcare system) in several ways: it can lead to loss of independence necessitating increased care requirements (and even institutionalization), depression, and reduced quality of life. Like the other geriatric syndromes, many cases of functional decline are avoidable during a hospital admission if proper measures are taken to prevent them. One consequence of the diminished reserves associated with frailty and age is that when functional decline occurs, it may be irreversible or require a prolonged period of rehabilitation to achieve partial or complete reversal. When functional decline occurs, the often prolonged hospital stays required for rehabilitation after a serious illness, although often unavoidable, bring further risks.