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