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MESH-ing to Avoid Unnecessary Hospitalizations

  • Apr 16, 2024
  • Cathy Gasiorowicz
  • 6-min Read

“Hospitals can be dangerous for older people,” said Dr. Bill Thomas (a.k.a., “Dr. Bill”), nationally renowned geriatrician, author, and Lifespark Independence Officer. “This is why Lifespark is laser-focused on helping seniors avoid unplanned and unnecessary hospitalizations.” In fact, new data from Minnesota hospitals show that one in six days of inpatient care was deemed unnecessary. That equals 65,000 days of hospitalized care that could have been avoided had the health concern been address at home or in another setting.

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For a generation that came of age in the 1940s and ‘50s, hospitals are still often seen as the first line of defense—and for that, Dr. Bill blames “Dr. Kildare,” a medical drama about an intern-turned-resident that aired 1961–66. “Dr. Kildare had all the answers and the place to get those answers was the hospital,” he said. “But in the real (non-TV) world, hospital admissions of older people are associated with an increased risk of injury, decreased function, and loss of independence.”

More harm than good?

Dr. Bill addresses this finding in his book, MESH: Move-Eat-Sleep-Heal, quoting studies that show that when elders are hospitalized, they’re likely to be discharged in a weakened state, sleep-deprived, undernourished, and exhausted. One of those studies, published in 2013 in the New England Journal of Medicine, found that older people who had recently been hospitalized experienced a period of generalized risk for myriad adverse health events—a phenomenon referred to as “post-hospital syndrome.”

According to Dr. Bill, this state of fatigue and frailty is a side effect of the acute care system’s myopic focus on diseases and its failure to look at all aspects for human well-being. “Young people are better able to tolerate this kind of treatment because they arrive at the hospital door with youthful reserves of stamina,” he said. “In contrast, older people often undergo life-changing losses of strength, balance, and endurance, even when their medical condition has been treated effectively.”

Unintended consequences

Even the most advanced medical tools and leading-edge technologies can’t overcome the detrimental effects of the hospital environment on older adults, Dr. Bill said. “Most benefits are offset by the unintended consequences of hospitalization, including immobilization, acute undernutrition, and fragmented sleep.”

The impact of immobilization on an older body is significant. Rapid muscle deconditioning, loss of core strength and balance, and decreased joint range of motion are linked to functional decline, increased frailty, and a higher risk of post-hospital falls. Prolonged immobility also contributes to blood clots, which, according to the Centers for Disease Control and Prevention (CDC), are a leading cause of preventable hospital deaths in the United States.

As for acute undernutrition, it’s not the lack of quantity of food that’s the problem, Dr. Bill said, it’s the overall experience. “By the time the food arrives, it’s lukewarm at best and not very appealing. But it’s also important to remember that eating is a social act, maybe the most common of all shared social experiences. But in the hospital, it’s done in solitary.” In his book, Dr. Bill cites a study of acute care patients, age 65 and older, which found that 40 percent of the food served to these patients was left uneaten. “Unlike younger people, elders just don’t have the reserves to compensate for four days of poor nutrition,” he added.

Finally, fragmented sleep is the norm in hospitals. “Patients are constantly interrupted by nurses making rounds to check their vitals, beeping machines and alarms, and sometimes roommates,” Dr. Bill said. “And at the risk of stating the obvious, poor sleep impedes the process of healing.”

My own recent hospital stay was a casebook example of what Dr. Bill described. Excellent post-operative care notwithstanding, the med-surg floor felt chaotic and stressful. Between the beeping monitors, the harsh florescent lighting spilling out from the nurses’ station, and the alarm that shrieked whenever my nasal cannula (the little gizmo that blows oxygen up the nose) got dislodged, it felt like torture. Fortunately, I was discharged 36 hours after admission. Some aren’t so lucky…

Helping your clients MESH

The most effective way to eliminate “post-hospital syndrome” is to stop unnecessarily admitting older people to the hospital, Dr. Bill said. But rather than rue the failure of hospitals to properly care for elders, he believes it’s more productive to ask, “What simple things make the biggest positive difference in the health and well-being of older people?” His answer, a combination of common sense, professional experience, and extensive research, is that people of all ages need to move, eat, sleep, and heal (a.k.a., MESH).

Move: “Our bodies are made to move every day and not moving leads directly to de-conditioning,” he said. “If people are to remain healthy or recover from illness or injury, they need to move.”

Eat: “People choose to eat or not eat based on a complex web of factors, including mood, food preferences, social expectations, rituals, and pleasurable sensations related to smell, as well as sight, hearing, and taste,” he said. “To return to health and wellness, each person should be able to choose the combination of food and sociability that suits them best.”

Sleep: “Simple practices—like developing rituals and routines to help sleep come more easily—will improve sleep hygiene,” he said. “It costs nothing but can lead people to experience better, deeper sleep, which goes a long way toward greater strength, purpose, and belonging.”

Heal: “Sixty years of popular medical dramas have convinced us that to be healed (in the span of a single episode no less) is to return to the way things used to be,” he said. “In the real world, healing is not a return to the way things were, it’s moving forward to find a new normal.”

Sometimes, of course, a hospital admission is necessary. “And thank goodness we have access to these extraordinary institutions of advanced technology that can accomplish amazing things,” Dr. Bill said. “But the sooner you can arrange what we call ‘a sweet discharge,’ the better off your client will be.”

Seniors who live in Lifespark-managed communities have the advantage of onsite geriatric medicine experts dedicated to helping them stay healthy at home. With services and support from Lifespark Skilled Home Health, Community Home Care, and Lifespark Hospice, people can age magnificently, wherever they call home.

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