The Question: My mother is in hospital. We feel she is not well enough to go home as she cannot get up to go to the bathroom or walk but they seem ready to discharge her. She walks with the help of a rollator and is medically stable. Our family wants her to stay in hospital because we are nervous about what happens when she goes home. What should we do?
The Answer: This question came through our Office of Patient Experience and it is one that doctors hear frequently. There are a couple of things to note right off the bat: doctors only send patients home who are medically stable and once that decision is made, the hospital often ceases to be the best place to convalesce.
“One problem is that because you are in hospital, you may wind up staying in bed more than you would in your own home,” said Dr. Steven Shumak, former head, division of general internal medicine at Sunnybrook Health Sciences Centre. “Not only does that weaken or decondition you it also sets you up for complications in your lungs as you are less likely to take deep breaths when in bed. In fact, every moment you spend in hospital increases the chance of a complication or infection.”
In hospital, patients tend to become less active and they quickly lose their muscle. That deconditioning causes them to stay in bed longer, creating this vicious cycle that can be difficult to break.
This is a significant concern for many hospitals, including this one, where the average age of patients cared for by internists like Dr. Shumak is 80 and the length of stay for them is around six or seven days.
Patients admitted to medical beds are acutely ill, coming through the Emergency Department. Common diagnoses include pneumonia, stroke, difficulty breathing, heart attack, or internal bleeding. They are some of the sickest and most complex patients doctors will treat and they are growing in numbers.
Seniors are the fastest-growing segment of the population; currently about 4.8 million Canadians are aged 65 and older. That figure is expected to more than double to 10.4 million by 2036 and by 2051, one in four will be older than aged 65.
Oftentimes, living a long life means living with several chronic medical conditions that require skilled clinicians to manage, especially when it comes to different medications.
For some patients who are older, the mere act of being admitted to hospital, with the changing faces of health providers, unfamiliar routine, bright lights, and sleep disturbances can be enough to precipitate delirium, a medically significant event characterized by sudden, severe confusion. Delirium doubles the length of a patient’s hospital stay for any given diagnosis.
“When it starts, delirium will typically begin at night, perhaps because people no longer have the visual cues they depend on,” said Dr. Shumak, an internist who has practiced medicine for more than a quarter century. “It’s very serious but beyond that, delirium can be persistent. It [can be] like a hangover you don’t get over.”
So I do share your concern what happens when a patient goes home – and seemingly is out of the hospital system – which is why I plan to write a future column on what happens after being discharged from hospital.
“No matter which way you slice it,” said Dr. Shumak, “Most patients are better off at home than they are in hospital.”
