Care at Home, Dementia, and Reducing the Risk of Deconditioning

Deconditioning, or a decline in physical fitness and wellness during a hospital stay, is challenging for anyone but especially difficult for people living with dementia. For these patients, challenges posed by deconditioning are exacerbated alongside the mental struggle of just being in the hospital. 

There is a unique solution to the problem of deconditioning in hospitalized dementia patients, however. Bringing healthcare home through programs like Contessa’s Recovery Care at HomeRehabilitation Care at Home and Palliative Care at Home removes many of the root causes of this negative healthcare outcome.

Deconditioning in practice 

So, what does deconditioning actually look like? In practice, deconditioning can be defined as physical changes that happen as a result of a change in activity level, such as bedrest. When someone experiences deconditioning, they lose their baseline level of functioning in areas such activities of daily living, mobility or cognitive ability.  

Although deconditioning can happen in many settings, hospitalization poses a particular risk for many people. For older adults, deconditioning is a common problem secondary to acute hospitalization. It has been labeled both as “hospital-acquired deconditioning” (HAD) and “post-hospital syndrome” (PHS).  

According to an article published in the Physical Therapy and Rehabilitation Journal, during a hospital stay, these older adults often spend 95% of their time in bed or in a chair, are 61 times more likely to develop disability in activities of daily living (ADLs) than those who are not hospitalized and 68% of them are discharged from post-acute care below their prehospitalization level of function.  

Hospital-acquired deconditioning and dementia 

It stands to reason that patients living with dementia would feel the impacts of hospital-acquired deconditioning even more significantly. At a baseline, these patients struggle with ADLs, cognitive decline and sometimes mobility challenges. Not surprisingly, a study published in the International Journal of Geriatric Psychiatry examining risk factors for HAD indicated that pre-admission functional status and cognition played a role in increased rates of HAD. 

By the same token, we can then expect that these patients may experience the complications of HAD in higher numbers as well. These complications include problems like increased length of stay, increased risk of readmission, decreased likelihood of being able to return home on discharge and even increased falls and mortality. 

Challenges hospital stays pose to conditioning 

Why is this? The level of conditioning our bodies maintain from simple tasks at home or just from having the freedom to move around is understated. With deconditioning, we can expect decreases in muscle strength at a rate of 2-5% per day, according to a study published in the journal Canadian Nurse. And with each day that passes, it takes many more days for that strength to be restored through rehabilitation, if at all in some cases. 

In a hospital, mainly for safety concerns and to ensure that care can be delivered efficiently, patients must conform to a schedule and environment with which they have no familiarity. For patients living with dementia, this causes a two-fold problem: restriction of movement to prevent wandering and falls, and confusion due to a foreign environment which leads to inability to participate fully in activities like physical therapy.  

The positive impact of being home 

The good news is that receiving hospital-level and post-acute care at home has a strong effect on preventing deconditioning. The familiar faces patients see while receiving care in the home are encouraging and comforting, particularly for those living with dementia. On top of loved ones helping to ensure patients carry out their daily tasks, the home setting is familiar and easier for people living with dementia to navigate – increasing the likelihood of participation in activities that promote mobility. 

Social well-being and its impact on prevention of deconditioning  

The positive influence of familiar faces and routines is already a known strategy for supporting people with dementia. Acute illness by itself can increase agitation and confusion in dementia patients, and paired with the unfamiliar hospital environment it is only exacerbated.  

In a typical hospital setting, lack of interaction can affect any older acutely ill adult; BMC Geriatrics published a study that found that decreased access to social connections such as family, roommates, and even volunteers and staff impacted older adults and led to deconditioning. Patients with dementia, with their tendency towards greater confusion in new settings, may struggle to make use of what limited social connections they do find in a busy hospital setting.  

At home, patients can receive care from the people who typically provide it for them. They can more easily visit with familiar friends or family. And their daily activities—meals, watching TV—can easily become social events in the home. 

Removing barriers to regular mobility

While having access to a nurse at the press of a button may seem to be a safety net, in some instances it results in hospital staff doing physical tasks that patients could complete alone. In the home, while nurses still visit at least twice a day and patients still can call for help, they are less likely to call a nurse for a simple physical task, of which they are safely capable of doing, helping them keep moving and maintain their strength. They’re also less likely to stay in the bed or chair, instead moving around for activities such as toileting and meals. 

Visibility into social determinants of health

One of the biggest benefits of bringing care home is that it gives providers the unique opportunity to see patients in their native environment. When trying to understand challenges that people face when living with dementia, it is helpful to see them as they engage in their typical daily lives. What are challenges that they commonly face at home? What routines are most familiar to them and prompt them to keep physically moving and interacting with their caregivers? 

By allowing healthcare providers to become more familiar with the social determinants of health impacting these patients, continued progress can be supported in the most effective ways for each patient. 

Better outcomes despite dementia with care at home 

Providing the best outcomes includes avoiding deconditioning, and it’s easy to see how a solution for this concern is care in the home. Patients living with dementia are especially susceptible to the dangers of inactivity during an inpatient stay. Getting patients out of the hospital bed and back into their familiar environment with their regular caregivers provides inherently specialized support for this vulnerable population of patients.  

As we continue to expand the continuum of care in the home, this approach is increasingly the gold standard for improved outcomes for many patients, including those with dementia. With low readmission rates and high patient satisfaction, Comprehensive Care at Home is proving every day that care where patients most want to be—at home—is best. 

Meet Our Expert

Robert Moskowitz, MD, MBA, Chief Medical Officer

Rob Moskowitz, MD, MBA, is dedicated to ensuring that patients receive high-quality care that is timely, accessible and comprehensive. As the Chief Medical Officer at Contessa, he leads all clinical and quality aspects of Contessa’s home-based care continuum. Dr. Moskowitz brings his experience as a practicing emergency physician to all aspects of his role at Contessa, seamlessly partnering with health system leaders to develop, implement and monitor industry-leading hospital care at home programs.