Hospitalisation is the act of being hospitalised or admitted to hospital for a period of time. The main goal of hospitalisation is to restore or improve health, so the patient can return home or to their baseline. (Traub, 2018) However according to medical writer Traub (2018) just being in hospital can cause certain problems and one problem sometimes leads to another. In this assignment the effects of hospitalisation are going to be discussed with reference to the adult patient, particularly the older medical patient. Some of these effects include; exposure to infection, increased risk of developing pressure sores, and an overall functional decline.
According to Alexander (2000), on admission, the assessment of a patient should always include consideration of the possible infection risks to which the patient may be exposed, as well as the risk the patient poses to other patients. This is because one of the greatest effects of hospitalisation for the adult patient is the risk of exposure to HCAIs, or hospital acquired infections such as Methicillin-resistant Staphylococcus aureus, more commonly known as MRSA. Staphylococcus aureus is a bacterium which is present in the nose or skin of over 50% of the population, some of these bacteria are resistant to antibiotics and these are known as MRSA. (Alexander, 2000). In many cases patients with MRSA are isolated into single rooms, and the MRSA protocol is then followed. This involves the use of PPE when treating or coming into contact with infected patients, along with safe disposal of all waste. This isolation of patients can often lead to loneliness, and can often be a very stressful experience on a patient. (Knowles 1993).
All patients are at risk of acquiring a HCAI, but the elderly age group are more vulnerable to their effects. According to a study published in Turkish Journals of Medical Science(2017), infections and HCAI’s are the most common cause of morbidity in elderly patients. In this study of 894 HCAIs, 214 of them were seen in patients over 65. In many of these cases, other infections were present such as Urinary Tract Infections(UTI) or Pneumonia. Seventeen of these elderly patients had mortality due to these acquired HCAIs. The study concluded hospital acquired infections presented in elderly patients have different clinical and microbiological characteristics to HCAI’s presented in other age groups having a greater effect on the older adult patient.
The presence of HCAI’s or infections in adult patients can often result in confusion or delirium. Delirium can be defined as an acute disorder of attention and cognition. (Inouye, 1996) It occurs particularly in elderly patients, and can be characterised by the presence of confusion, disorientation and agitation. A patient experiencing delirium will usually be loud, talkative, offensive, suspicious and agitated. (Plum ; Posner, 1980). The risk of patients experiencing delirium can range from 6% to as high as 56% during a hospital stay. (Fong, T. G., Tulebaev, S. R., ; Inouye, S. K, 2009). A study carried out by the Journal of American Geriatrics(1988) society determined that a UTI present at any time during a hospital stay, and an elevated white blood cell count on admission are high risk factors for delirium. Delirium can affect the patients cognitive ability, and their overall physical and cognitive function. Thus, its important that any patient suspected to be delirious is given treatment immediately. Non-pharmalogical strategies are the first sought treatment for a delirious patient, these include re-orientation; use of sensory aids such as glasses, hearing aids where applicable and a reduction in the use of physical restraint in order to reduce further confusion. (Fong, T. G., Tulebaev, S. R., ; Inouye, S. K, 2009) If delirium is not treated immediately it may prevent the patient from returning to their baseline function and effect the overall outcome and prognosis of patients, which may result in a need for full-time care in a nursing home on discharge. Failure to identify delirium on time can lead to permanent confusion, or the onset of dementia aswell as rapid functional decline for the patient.
In many cases, patients that develop delirium are patients with a decrease in mobility since admission. This maybe due to a history of falls, their admitting diagnoses, or just a general deterioration in the patients condition. Bed rest and a decreased mobility in older patients can greatly influence functional decline in such patients. According to Kortebein et al (2008), 10 days of bed rest results in a noticeable loss of lower body strength, power and aerobic capacity in a healthy older adult with an overall effect on their physical activity. A decrease in mobility in older patients can often lead to failure to return to their baseline independence, leaving the hospital more dependant and needing greater assistance than pre-admission. For example, a report published in the Journal of the American Geriatric Society (2003) reported that 35% of their participants (2,293 patients over the age of 70) declined in ADL functions between baseline and discharge. They concluded that the older patients are at higher risk because they are least likely to recover ADL function lost before admission and are the most likely to develop further functional deficits during the length of their hospitalisation.
Another effect of hospitalisation is malnutrition, which can occur after a long-term hospital stay or in some cases of delirium. Malnutrition can often be commonly found in surgical patients, as according to Torrance(1991), surgery has a profound impact on metabolism which can cause a complex neuroendocrine response which shows similarities to the body’s response to starvation. Similarly, patients with malignancies, inflammatory bowl disease and other chronic diseases such as cardiac and lung diseases are at higher risk of malnutrition. According to Tierney (1996), surveys have suggested between 22 and 50% of hospital patients could suffer from malnutrition. Hospitalisation may also predispose patients to malnutrition due to the emotional trauma and strain; the unfamiliarity of their surroundings may reduce their appetite and similarly the hospital food made not be to the patients taste. Similarly, patients maybe kept fasting before many procedures such as before MRI scans, colonoscopy, or other investigations. Malnutrition can impact on a patients overall recovery, as well as their length of stay in hospital. If the body is under-nourished in a longer recovery time, thus increasing the length of their hospital stay, and the patient can become more at risk of infection; for example, postoperative infection is particularly linked to undernutrition. (Alexander, Fawcett, Runciman, 2000).