General Deconditioning Flashcards
1
Q
General deconditioning
A
- does not have an ICD-10 code
- is not a real disorder or a real disease
- is what happens to your body and you’re on prolonged bed rest or you’re inactive
- a process of physiological change caused by a decline in activity that results in decreased functional participation and independence due to weakness and other related factors
- inactivity leading to general deconditioning can occur at any age
- more common and particularly concerning for individuals with physical disabilities
- older adults (age 65+) because it can lead to irreversible functional decline
- limits a person’s ability to function independently but also increases the risk of falling, incontinence, malnutrition, disrupted sleep patterns, anxiety and/or depression, unexplained chronic pain, impaired cognitive function, hospitalization, and reduced ability to live independently in the community
- general deconditioning among older adults has been shown to quickly progress to irreversible functional decline, decreased life expectancy, and decreased quality of life
- means that they cannot do their daily activities and occupations because of either being in the hospital for too long or deconditioning not related to being in the hospital
- has no standard definition or even terminology used by medical professionals
- hospital-associated deconditioning (HAD)
- post intensive care syndrome (PICS)
- deconditioning not related to hospitalization
- defined as a complex process of physiological, multisystem changes caused by aging, a period of physical inactivity, or both, which results in weakness and functional decline
- functional decline describes how the physiological changes result in an inability to perform activities of daily living (ADLs), such as standing and walking, resulting in decreased independence and safety
- less autonomy and independence, decreased quality of life, increased risk and length of hospitalization, increased risk of illness and death, and institutionalization
- the decline can be irreversible
2
Q
Slide 6 diagram
A
- event/condition triggering inactivity
- risk factors
- period of inactivity
- all there of them leads to functional decline
3
Q
Gravitational deconditioning
A
- effect from spending prolonged periods of time in a lying position
- bed rest
- may produce a reduction in blood volume, which can lead to a loss of bone and muscle mass
- it is often necessary during treatment of critical illness to maintain the function of tubes and lines, retain proper bone or spin alignment, reduce the risk of falling, and prevent injury for medical staff
- ex: broken pelvis = immediately stand up after surgery and it gets healed in 2-3 weeks because of weight bearing and increased blood circulation
4
Q
Debility
A
- sometimes used interchangeably, though it is often referred to as a diagnosis, while deconditioning is used as a general descriptor for functional decline
- can be used as an admission diagnosis for inpatient rehabilitation
- defined as generalized deconditioning not attributable to any other impairment groups, such as a stroke or orthopedic conditions
5
Q
Classification of deconditioning
A
- not a good thing to stay supine position
- no single assessment to comprehensively classify or measure its severity (a vague term)
- mild deconditioning = described as a change in a person’s ability to participate in physical exercise, such as running, biking, or swimming
- moderate deconditioning = a change in a person’s ability to do typical instrumental activities of daily living (IADLs)
- severe deconditioning = a change in a person’s ability to participate in usual ADLs
- differentiate between deconditioning caused by acute inactivity (such as bed rest during acute illness) and chronic inactivity from a sedentary lifestyle, which is often more difficult to reverse
6
Q
Hospital-associated deconditioning (HAD)
A
- decline correlated with hospitalization
- specifically among the elderly but also including all ages of persons with a physical disability
- a functional decline caused or worsened by hospitalization, unrelated to a neurological or orthopedic condition
7
Q
Bed rest is bad diagram (slide 11)
A
Immobility is associated with the following negative outcomes:
- thromboembolic disease
- joint contractures
- atelectasis
- skeletal muscle atrophy and weakness
- pressure ulcers
8
Q
Did your patient get out of bed today?
A
- even if your patient cannot walk far, encourage them to get out of bed as much as possible
- stand beside bed
- move to chair
- eat in chair
- stand while brushing teeth
9
Q
Did your patient walk around the room today?
A
- if your patient is able to walk small distances, encourage them to try these activities in their room
- walk to bathroom
- brush teeth in bathroom
- walk to and from door
- walk to and from door prior to each meal
10
Q
End PJ paralysis (slide 14)
A
- patient time is most important currency in health and social care
- up to 60% of older patients experience functional decline after hospitalization
- deconditioning in hospitalized older people can cause serious harm
- let’s get patients up, dressed, and moving, enabling them to get home to their loved ones safer and sooner
- every day matters
PJ paralysis facts: - recudes mobility
- loss in strength
- loss in independence
- longer stay in hospital
11
Q
Post intensive care syndrome (PICS)
A
- the hospital’s jobs is to keep the patient alive, then our job as OTs is to return them to living
- increasing number of patients are serving life-threatening conditions that require treatment in the intensive care unit (ICU)
- significant functional disabilities in many surviving patients
- a disability that affects ICU survivors, including impairment in cognition, psychiatric health, and/or physical function
- defined as “new or worsening impairment in physical (ICU-acquired neuromuscular weakness), cognitive (thinking and judgment) or mental health status arising after critical illness and persisting beyond discharge from the acute care setting
12
Q
PICS causes…
A
- cognitive impairment = global cognitive function, executive function, memory, and attention
- mental health impairment = anxiety, depression, and post traumatic stress disorder
- PICS-family = anxiety, depression, post traumatic stress disorder, and complicated grief
- physical impairment = muscle wasting and weakness, decreased mobility, pain, fatigue, shortness of breath, and reduced appetite
13
Q
Deconditioning not related to hospitalization
A
- when you are not exercising your lung muscles, leading to shortness of breath
- “out of shape”
- the effect that sedentary behaviors and/or immobility have on health and functioning
- not fatigue caused by a medication condition, rather immobility
14
Q
What deconditioning is NOT
A
Sarcopenia:
- describes the loss of muscle mass related to aging, not immobility
- can be worsened by inactivity and increases the risk for HAD
Frailty:
- appears slowly and very subtly over a longer period of time
- weakness, fatigue, compromised functional activity, incontinence, poor nutrition, increased anxiety, chronic pain, and increased fear of falling
- more functional loss
- social isolation and cognitive deficits
Fatigue:
- decreased endurance caused by a medical condition that cannot be remediated with rest, unlike overexertion during activity
- fatigue caused by several chronic conditions, such as multiple sclerosis (MS), fibromyalgia, and chronic fatigue
15
Q
Etiology of deconditioning
A
- reduced activity level of immobility
- risk factors for immobility and deconditioning include illness, physical disability, chronic disease, medication side effects, psychosocial conditions, malnutrition, cognitive decline, and older age
- health people with bed rest = some degree of weakness and stiffness
- person who is physically disabled or an older adult = the effects of immobility are accelerated if they were already experiencing some degree of muscle impairment (a more serious loss of function, which is also more difficult to reverse)
