Upon admission to hospital Mrs. Murphy, age 81, lays down comfortable in bed and is reluctant to get up. “I am in the hospital because I am ill and I need to stay in bed and be cared for,” she says. “I need to rest and regain my strength and get well.”
The myth that bed rest is good for you is strongly ingrained in our society. A study BY Hirshch (1990) on patients over the age of 74 noted that by the second day of admission statistically significant deterioration had occurred in “individual scores for mobility, transfer, toileting, feeding and grooming.
Many older adults become dependent in one or more activities of daily living (ADLs: dressing, bathing, transferring, eating, toileting) when hospitalized and their prognosis after discharge is poor.
A study by Boyd and Landefeld (2008) showed that at 12 months after discharge, of those discharged with new or additional ADL disability, 41.3% died, 28.6% were alive but had not recovered to baseline function, and 30.1% were at baseline function. Hospitalization and bed rest superimpose factors such as enforced immobilization, dehydration, accelerated bone and muscle loss, urinary incontinence and sensory deprivation. Any of these factors may begin the downward cascade into a state of irreversible functional decline.
The factors that contribute to a cascade to dependency are identifiable and can be avoided. Health care providers need to encourage mobility and independence be teaching their patients about the detrimental effects of bed rest. The Bed is not your patients friend.
Look at the patient lying in bed
What a pathetic picture he makes
The blood clotting in his veins
The lime draining from his bones
The scybala stacking up in his colon
The flesh rotting from his sweat
The urine leaking from his distended bladder
And the spirit evaporating from his soul
Poem by Richard Asher, MD
Our guest blogger this week is Bronia Michejenko, RN, MSN, GNP, BC.
References
Boyd. C., Landefeld. C. Counsell S., Pammer. R. (2008) Recovery of activities of daily living in older adults after hospitalization for acute medical illness. J Am Geriatr Soc., 2008, 56(12), 2171–2179.
Hirsch. C. (1990). The natural history of functional mobility in hospitalized older patients. J. Am Geriatr. Soc., 38(12), 1296-1303.
Join us for a real-time discussion about questions raised by this essay on Wednesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.
Rodger Marion 
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