ICU patient: via MedPage Today Two separate studies released today suggest that hospitals may not be the place to be if you are sick, especially if you are seriously ill and/or elderly. And it's not just the the racket hospital staff makes trying to raise the roosters, or the insertion of a new IV catheter in your wrist....
In one study, conducted by the Department of Physical Medicine and Rehabilitation and the Division of Pulmonary and Critical Care Medicine at Johns Hopkins University, participated in a large study evaluation long-term physical and mental health outcomes of patients in intensive care units (ICU) from several institutions. The results indicated that patiets had impaired strength, range of motion, and physical function.
At Johns Hopkins Hospital (JHH), it was found that less than a quarter of the patients in the intensive care unit (ICU) were ever evaluated for physical or occupational therapy; in part, they report, because the patients were delirious or deeply sedated. Fortunately, the researchers decided to change the protocol to the following:
- Change the standard medical ICU admission orders from "bed rest" as the
default to "as tolerated."
- Switch sedation and pain medications from continuous
intravenous benzodiazepines and narcotics to "as needed" bolus doses.
- Establish guidelines for physical and occupational therapy consultation.
- Ensure that a full-time physical therapist, occupational therapist, and
part-time rehabilitation therapist were available on staff.
- Increase consultations with neurologists for patients with severe or
prolonged muscle weakness.
The results of testing this new protocol on just one group of ICU patients at the JHH were so positive that the hospital protocol was permanently changed for all ICU patients.
Hospitalization and cognitive decline: Credit: iStockphoto/Joseph Jean Rolland Dub
- The results of the for the proportion of patients taking sedatives and/or narcotics dropped from around 96 percent to 73 percent and 77 percent respectively.
- Patients were more alert during their stay.
- The proportion of patients who got any physical or occupational therapy, or
both, in the ICU rose to 93 percent from 70 percent. The number of
treatments per eligible patient increased as well, from one to seven
- Once the new protocol covered all ICU patients there were two to four times more physical and occupational therapy treatments and treatments were four times the average in one day.
In the second study released today, researchers at the University of Washington
, Seattle, followed 3,000 adults for six years. None of the participants had dementia at the beginning of the study. However, after six years, of those who had dementia, there were 40 percent more cases who had been hospitalized for a non-critical illness one or more times in that six year period.
The Washington researchers are not sure why such a difference exists. Some factors, they write, may be linked to low oxygen levels in the blood, delirium, inflammation, and medications administered. They suggest further exploration.
I witnessed both the loss of physical ability and the cognitive decline of my 90-year-old mother recently. I went to see her on her first evening in the hospital. Diagnosed with a urinary tract infection, she was hooked up to an IV and had to eat a "soft diet," the most abominable stuff you could imagine. She ate as much as she could stand that night, she talked in full sentences, just like always, and asked me questions about how things were going at home. But every day she was weaker and ate less. No therapist or nurse or aid came to walk her or even sit her in a chair. We asked that she receive physical therapy, but were told that was not recommended by her doctor. Her doctor said someone would come to see her when she went home.
My mother was literally affixed to her bed with IVs and monitors.
After her release from a six-day stay at the hospital, my mother could no longer walk, even with assistance, nor could she express more than a few words spontaneously; what was a moderate short-term memory loss one week before is now full-blown dementia. She has extreme pain in moving her arms and legs. She has to be fed by a tube in her stomach. The treatment for the UTI was successful.
MedPage Today 4/9/2010, MedPage Today 1/29/2010, HealthAndAge.com