Sunday, 20 July 2014

"Stressful Hospital" Syndrome

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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