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What is functional decline?

Functional decline is the decrement in physical and/or cognitive functioning  and occurs when a person is unable to engage in activities of daily living, as is encountered during hospitalisation.

Functional decline can occur as early as day two of hospitalisation. In 30 per cent of hospitalised older people, functional decline is unrelated to their primary diagnosis. At three months post discharge only 50 per cent recover from functional decline.

Functional decline has been identified as the leading complication of hospitalisation in the elderly and can result in under-nutrition and dehydration, decreased mobility and loss of independence, accelerated bone loss, delirium and depression, pressure ulcers and skin tears and incontinence.  These hazards can be prevented or minimised during an older person’s hospital admission by implementing effective strategies to minimise functional decline.

Why should I be concerned about functional decline in older people during their hospital stay?

Hospitals can be dangerous for older people:  Some of the problems that older people experience in hospital include:

  • Under-nutrition and dehydration - due to patients' inability to manage their meals and drinks independently and lack of assistance with meals and drinks, missed or interrupted meals due to conflicting appointments, reduced appetite due to illness or lack of activity.
  • Decreased mobility and loss of independence – can be aggravated due to patients staying in bed, lack of incidental activity, illness or impairment.
  • Skin integrity issues including pressure ulcers - due to continuous pressure on frail skin and poor mobility or blood circulation.
  • Incontinence - due to reduced mobility, increased urgency, poor orientation to bathroom, use of continence aids, constipation or effects of medication.
  • Falls - due to impairment, environmental hazards or confusion.
  • Delirium - a clinical syndrome due to infection, sleep deprivation, immobility, dehydration, pre-existing cognitive impairment or medication.
  • Medication errors - due to taking incorrect medication, incorrect dosages or medication side effects.
  • Depression - due to ill health, loss of function or poor recovery.

These problems occur in addition to the patient’s presenting conditions. They can impede recovery, increase length of stay and lead to reduced functioning, not only when compared to pre-morbid functioning, but when compared to a person's functioning on admission to hospital.

What can I do to reduce functional decline in older people?

As health professionals working in hospitals we can make a difference. What we do, or don't do, will affect an older person's likelihood of functional decline.

There are some very practical things we can do. For example, ensure that every patient is oriented to the ward environment so they:

  • know how to get to the bathroom
  • have a call bell within reach
  • know where the nurses' station is
  • know where to go for meals, if dining in a dining room.

Patients may need to be reminded about where things are on more than one occasion.

Central to this is putting person-centred care into practice. Put simply, this means treating older people with respect and as equal partners in the health care relationship. We need to listen to the older person, take time to get to know them and engage with them as an equal.

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