You are in pain, and taken to a strange place. You are placed in a cell with a stranger, and your sleep is interrupted at odd intervals by other strangers, who torture you with sharp instruments, and give you mind-altering truth serums. The food is terrible, and sometimes you are not even allowed to eat that. You are afraid that greater pain awaits, or that you will never get out. You are not Jack Bauer in a Chinese prison.
You are in a hospital.
Is it any wonder that when people, especially the elderly, are discharged from the hospital, nearly one-fifth are readmitted or have a serious illness within thirty days? This is the subject of this week’s New England Journal of Medicine article: The Post-Hospital Syndrome by HM Krumholz.
Dr. Krumholz identifies this problem and makes a number of systemic recommendations, such as better assessment of patients before discharge, taking care to minimize delirium brought on by medications, and better maintenance of nutrition and stamina during the hospitalization. I have seen this many times in my own family, as older members enter and leave the hospital. As doctors, these are all things we can pay attention to right now. But lay people need to know about this problem as well. If you have a family member in the hospital, what can you do?
Familiar surroundings, comfort, and return to routine as much as possible as soon as possible are important for calming the mind, and reducing the effects of medications, stress, and unpleasant new people and experiences. (yes, as much as we hate to admit it, we medical professionals are unpleasant, simply because we order such unpleasant treatment.) This is a good time to limit visitors, adhere to normal sleep schedules, and try to minimize oversleeping.
Stress and poor nutrition from hospitalization weaken the immune system, which is another good reason to limit visitors in the first couple of weeks after hospitalization. But if post-hospital care is taking a toll on the family, it is perfectly appropriate to get help from an aide. You need to keep yourself healthy, too, in order to take good care of your patient.
Good food and adequate fluid is key. Your patient may not be hungry, or able to eat much at first. Feed them the healthiest food they like, and offer it frequently. Frequent small meals often are easier to digest than larger meals, and keep blood sugar levels on a more even keel.
Activity is also important. Do the PT exercises, walk around the house, encourage activity as much as possible. Unless your patient simply can’t get up, because of a medical issue, activity is one of the most important things you can do. Keep it short and easy at first, and increase every day. Physical activity reduces the risk of falls, blood clots, and heart attacks after bedrest.
These 4 points are basic common sense, but easily forgotten in the clamor of new drugs, doctor’s appointments, post-op pain, and often a scary new diagnosis. Your doctors and nurses have their own agendas, and may forget to talk to you about doing these simple things. As this article shows, we need reminding ourselves.
Have you had any other challenges after bringing someone home from the hospital that you’d like to talk about?