Think about an older person, someone in their eighties – let’s say it’s your Granma…
Your Granma lives in her own house; she’s not quite so good on her feet anymore, but she gets about OK. Stairs are difficult but she manages – and she manages to get up and dressed, make her breakfast and her tea, feed her cat, read the paper, get to Tesco in the car with you.
Then your Granma gets ill – she has say, a chest infection. She is admitted to hospital. You pack her bag – nightie, toothbrush, comb. She is admitted to the ward – she is poorly, needs antibiotics and a drip for a few days. So, on goes the nightie and your Granma is in bed; that’s what you do in hospital – you are poorly and tired and you need to rest in bed.
Your Granma is in bed in her single room. She needs the toilet but doesn’t think she should get up by herself – she is a patient in a nightie so needs help. But she can’t see very well or hear very well and can’t find her glasses or hearing aids. She can’t find the buzzer to buzz the nurses and she can’t hear when they are near. She thinks maybe she could get herself to the toilet, but she can’t see her walking sticks and is scared she will fall.
Time passes. Your Granma is incontinent in the bed. She is embarrassed and frightened – what will the nurses think?
Now she is scared to drink and eat because she doesn’t want to need the toilet and be incontinent again. And she doesn’t want to bother anyone. The physio comes to see her, tries to get her up. But she is still embarrassed and frightened. She has no clothes to wear. And she has only those foam slippers she got from the nurse. So it’s best just to stay in bed.
Your Granma stays in bed for longer and longer. There is nothing to do. There is a TV but she can’t see it or hear it without her glasses and hearing aids. She is getting mixed up now; she can’t remember when she came here or why or what day it is. She thinks she can see cats in the corner of her room. She still won’t eat, so she has no strength and feels weak. She doesn’t want to get up. Her bottom and back hurt. Her leg has swollen up – they said it is a blood clot.
The physios keep coming back. They try to get her up; two of them struggle to get her to stand. She is stuck in bed.
Your Granma’s chest infection has been treated and she has no acute medical illness, but now she is immobile, confused, dehydrated, incontinent, her muscles are weak and she cannot walk anymore, or get herself washed or dressed.
Your Granma is not going to manage at home anymore; she has to go to a care home.
“GET UP, GET DRESSED, GET MOVING”
At DGRI, we are launching our campaign on Monday 23rd July– the aim is help our patients maintain their function, mobility and independence while in hospital, and for them to return home as soon as possible, as able as possible.
WHY HAVE THIS CAMPAIGN?
- Most patients in hospital are over 65
- In hospital, older people spend up to 83% of their time in bed
- 65% of people’s functional ability declines during admission
- 60% immobile older patients in hospital have no medical reason to stay in bed
- If you are over 80, 10 days in hospital ages muscles by 10 years
- 1 week of bed rest equates to 10% muscle loss
- These changes are “deconditioning” – “reconditioning” takes twice as long
WEARING YOUR PYJAMAS IN HOSPITAL
- Affects your confidence and self-esteem
- Changes how you interact with healthcare staff and other people
- Is usually unnecessary no matter why you are in hospital
- Doesn’t feel very dignified when you are trying to eat your dinner
STAYING IN BED IN YOUR PYJAMAS
- Reduces muscle strength
- Reduces confidence
- Reduces function
- Increases blood clots, delirium, pressure sores and infections
- Leads to reduced appetite, low mood and anxiety
- Reduces social interactions
- Lowers pain thresholds
- Can make blood pressure drop
- Causes constipation and incontinence
WHAT CAN HEALTHCARE STAFF DO?
- All of us can and should help patients get moving – nurses, doctors, AHPs, porters, domestic staff, pharmacists…
- Ask the patients how they normally get about and what they normally do
- Make sure patients can access buzzers, water, remote controls
- Encourage patients to get dressed and sit up in the chair
WHAT CAN PATIENTS DO?
- Tell us how you normally get about and get things done and what you need to help you
- Try to do things that you do at home – wash and dress, eat and drink on your own if able
- Sit up in your chair and for meals
- Drink lots
- If you can’t get out of bed, do little things – wiggle your toes, do a crossword – every little movement helps
WHAT CAN VISITORS DO?
- Tell us what you do at home
- Bring in glasses, hearing aids and walking aids
- Bring in comfortable day clothes and well fitting shoes
- Encourage you to sit up in the chair and for meals
- Take you for a walk
- Bring in photos, books, puzzles, crosswords
- Speeds recovery
- Reduces time in hospital
- Encourages patient and carer involvement in healthcare and recovery
- Helps to retain patients’ individuality and self-esteem
- Helps patients to quickly return home, mobile and functional
If you or your family are worried that it is not safe for you to get up or you might do the wrong thing – ASK US! We will tell you what is safe and OK for you!
Amy Conley is a Consultant in Geriatric Medicine at Dumfries and Galloway Royal Infirmary