What is interesting
in this article is that many of the drivers are arguably endemic in the daily life of many of us:
- Nearly one fifth of Medicare patients discharged from a hospital —
approximately 2.6 million seniors — have an acute medical problem within
the subsequent 30 days that necessitates another hospitalization. These
recently discharged patients have heightened risks of myriad
conditions, many of which appear to have little in common with the
initial diagnosis. For example, among patients admitted for treatment of
heart failure, pneumonia, or chronic obstructive pulmonary disease
(COPD), the cause of readmission is the same as that of the index
admission for only 37%, 29%, and 36%, respectively.1
The causes of readmission, regardless of the original admitting
diagnosis, commonly include heart failure, pneumonia, COPD, infection,
gastrointestinal conditions, mental illness, metabolic derangements, and
trauma Proportions of Rehospitalizations for Causes Other Than the Condition at Initial Discharge.).
The breadth of these readmission diagnoses has been shown in studies
using administrative claims and those using chart reviews. Thus, this
observation is not likely to be merely the result of variation in
coding. Further evidence of the distinctiveness of this syndrome is that
information about the severity of the original acute illness predicts
poorly which patients will have an adverse medical event soon after
discharge and require readmission.
How
might the post-hospital syndrome emerge? Hospitalized patients are not
only enduring an acute illness, which can markedly perturb physiological
systems, but are experiencing substantial stress. During
hospitalization, patients are commonly deprived of sleep, experience
disruption of normal circadian rhythms, are nourished poorly, have pain
and discomfort, confront a baffling array of mentally challenging
situations, receive medications that can alter cognition and physical
function, and become deconditioned by bed rest or inactivity. Each of
these perturbations can adversely affect health and contribute to
substantial impairments during the early recovery period, an inability
to fend off disease, and susceptibility to mental error.
These drivers will be familiar to those who hang around the paleosphere. Think 'resilience' when attempting to improve your health (adaptability trumps 'adapted'), the foundations of which are laid down by attention to sleep, nutrition, exercise and stress levels.
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