The Dangers of Hospital Admission 1

A few years ago I visited an old friend who had been admitted to hospital for treatment of an infection which was not responding at home. I found him seated in a chair by his bed – recovering but still weak and unsteady on his feet. I offered to take him for a walk but was prevented from doing so by the nursing staff – too dangerous. What if he fell? So his recovery was impeded by a complete lack of remobilisation apart from a visit from the physiotherapist every other day.

The dangers of hospitalisation

Deconditioning

A recent article in Clinical Medicine examines the often under-recognised dangers associated with hospital admission, especially for frail older adults. Although hospitals are designed to diagnose and treat illness, admission itself can produce significant physical, cognitive, emotional and functional harm. The main problem is “deconditioning” — the rapid decline in physical and mental function that can occur during even short hospital stays.

Hospital-related decline is not confined to prolonged admissions. Deterioration can begin within hours of arrival in the emergency department or acute medical unit. Older adults are especially vulnerable because many already live close to the threshold of frailty before becoming acutely ill. A seemingly small reduction in mobility, nutrition, hydration or sleep can therefore trigger a cascade of decline that persists long after discharge.

Hospitalised patients, particularly older people, spend the overwhelming majority of their time lying in bed or sitting inactive. This leads to rapid loss of muscle strength followed by impaired balance and reduced cardiovascular fitness. In frail patients this may mean the difference between independent living and dependence on carers or institutional care.

Multisystem harm

Deconditioning is not merely a physiotherapy issue but a multisystem syndrome. Immobility contributes to pressure ulcers, venous thromboembolism, constipation, urinary retention, pneumonia and insulin resistance. Reduced movement also increases the risk of delirium and falls. And these complications interact with one another. For example, delirium may reduce mobility further, while infection or poor nutrition worsens weakness and cognitive dysfunction.

Delirium

Delirium one of the most serious complications of admission in older adults. It is an acute disturbance in attention and cognition that is frequently precipitated by the hospital environment itself. Sleep deprivation, noise, unfamiliar surroundings, frequent observations, dehydration, infection and medications all contribute. Delirium is associated with increased mortality, longer admissions, falls, institutionalisation and persistent cognitive decline.

Hospital acquired infection

Admission exposes patients to resistant organisms, invasive procedures and close contact with other unwell individuals. Frail or immobile patients are particularly susceptible to urinary tract infections, pneumonia and bloodstream infections. These infections may not just prolong recovery but can permanently worsen function in older adults. A patient admitted with a relatively minor illness may leave hospital unable to return to their previous level of independence because of complications acquired during the stay.

Nutrition

Nutrition and hydration are further critical, but frequently neglected, aspects of care. Many hospitalised patients experience prolonged fasting for investigations or procedures, poor appetite, difficulty accessing food trays, or inadequate assistance with eating and drinking. Dehydration and malnutrition accelerate muscle wasting and worsen delirium risk.

The hospital environment

The hospital environment itself is potentially harmful. Constant noise, bright lighting, sleep interruption and loss of familiar routines contribute to distress and disorientation. Older adults may lose sensory aids such as glasses or hearing aids, further impairing communication and orientation. Emotional trauma and loss of autonomy are also often underestimated harms of admission. Patients may become passive recipients of care, discouraged from performing activities which they usually manage independently. This “learned dependency” contributes to long-term functional decline.

Investigations and treatments

Being in hospital exposes the patient to the risks of overmedicalisation and unnecessary intervention. Admission may trigger cascades of investigations, monitoring and treatment. While many are appropriate, others expose patients to avoidable risk. False-positive test results can lead to further invasive procedures. Polypharmacy increases the likelihood of adverse drug reactions, falls and confusion.

Next time I will discuss how we might handle all this!