DIAGNOSIS UNPREPARED: Elderly hospital patients need to keep moving

22nd August 2016   ·   0 Comments

By Anna Gorman
Contributing Writer

Part 2 of series

(Special from Kaiser Health News/New America Media) – Thelma Atkins ended up in the University of Alabama at Birmingham (UAB) Hospital-Highlands after a neighbor in her senior living center ran over her feet with a motorized scooter.

Terri Middlebrooks, a nurse at the hospital, tried to figure out how active the 92-year-old Atkins was before the incident. “Are you up and moving at home,” she asked?

“I can manage, but I have to have help sometimes,” Atkins replied.

Atkins said she uses a walker to visit friends and to get to the communal dining room. But she’s also fallen a few times in recent years.

“Don’t quit walking here,” Middlebrooks told her. “It’s the most important thing you can do.” She added, “This bed is not your friend.”

Excessive Bed Rest Harmful to Seniors

Middlebrooks is the coordinator of a unit designed to address the challenges specific to caring for elders. She told her new patient that throughout her stay, one of the primary goals would be to keep her active.

The medical center’s effort to get older patients up and to move while they are in the hospital is far from typical. Despite a growing body of research that shows staying in bed can be harmful to seniors, many hospitals still don’t put a high priority on making them walk.

At UAB Hospital-Highlands’ 26-bed geriatric unit, known as the Acute Care for Elders unit, or ACE, patients are encouraged to start moving as soon as they arrive. The unit is one of a few hundred around the United States that is attempting to provide better and more tailored care to geriatric patients.

The hospital opened the unit in 2008 with the recognition that the elderly population was growing and that many older patients didn’t fare well in the hospital. ACE units are based on the idea that if the unique needs of seniors are met, they will have better outcomes, and their care will be less costly.

Research has shown that the units shorten patients’ stays in the hospital, reduce their likelihood of returning too soon after discharge and make it less likely they will be sent to a nursing home.

In addition to employing specially trained staff, who work together as a team, the Alabama unit has special handrails attached to the walls, low-glare lighting, and non-skid floors. Every room has a walker and plenty of space to move around. Volunteers walk with patients, and therapists work with them on maintaining their strength.

Staff members try to disabuse patients of the idea that they are there to rest. “People walk in the door of a hospital and think it’s OK to stay in bed. It’s not,” said Middlebrooks.

Andres Viles, a nurse coordinator, said nurses at other hospitals are often so busy administering medications and tending to wounds that they don’t make time to walk with their charges. The emphasis on patient mobility is “a culture change” for most hospitals, he said.

At UAB Hospital-Highlands, that shift took a lot of education. Staff members in the new unit attended workshops that included roleplaying and sensitivity training. The hospital also trained “geriatric scholars,” who became advocates for addressing the particular physical and cognitive needs of seniors.

A ‘Cost” for Falls Prevention

The Affordable Care Act explains some of the reluctance by staff at many hospitals to get patients moving, experts say. Under the law, hospitals are penalized for preventable problems, including falls. Researchers believe that hospital staffers, to ensure their patients don’t fall, often leave them in their beds.

“We are doing an awful lot to prevent falls, but there is a cost,” said Heidi Wald, an associate professor at the University of Colorado School of Medicine. “The cost is decreased mobility.”

Researchers said there are other explanations for the failure of hospitals to get elderly patients moving. They may not have enough staff, for example, or they may fear lawsuits.

Families won’t sue if their mom gets weaker in the hospital, but they may if she falls, said Cynthia Brown, director of the Division of Gerontology, Geriatrics and Palliative Care at the UAB School of Medicine.

“Why would the hospital want to put themselves at risk for litigation or the CMS [Centers for Medicare and Medicaid Services] coming back and biting them,” she said?

Brown added that hospital staffers around the country do not consider walking with patients to be as important as their other duties. “It is just one more thing on a list of a whole lot of things,” she said. “Often times, walking falls to the bottom.”

It’s also harder for patients to walk around if they are attached to IV lines or oxygen tanks, or if they take drugs that make them sleepy. Such medication or equipment is not always necessary.

Dancing—Under Doctor’s Orders

The hospital hosts a twice-weekly session called “Move and Groove,” designed to get older patients dancing. At a recent session, a music therapist played the piano as the patients held tambourines or bells and moved their feet to the beat. All of the patients used walkers. A few had oxygen tanks and most wore bracelets indicating they were at risk of falling.

Occupational therapist Linda Pilkerton said she doesn’t give patients a choice of whether to participate.

“We don’t ask them if they want to do an x-ray or if they want a CT scan,” she said. “This is ordered by the doctor. If they don’t get up and move, they start the death spiral.”

After Atkins had been admitted to the unit following the scooter mishap, Middlebrooks told her it would only take two days of lying in bed to lose muscle mass. “And if you lose muscle mass, you get weaker, and you’re more apt to fall,” the nurse explained, adding that Atkins had done enough of that.

Atkins, who has a pacemaker and has had hip and hernia surgeries, said she has lived alone a long time and didn’t want to end up in a nursing home. As she pushed her walker down the hospital corridor, she acknowledged that she’s gotten weaker as she’s gotten older and that her arthritis makes it harder to shower and dress by herself.

But she said she’s determined to keep walking — at home and in the hospital.

“I don’t want to lose more independence,” she said. “I’ve already lost a lot of it.”

Recovery Not Guaranteed

But even if patients spend a lot of time out of bed while they are in the hospital, it does not guarantee they will recover.

Willie Mae Rich, 86, came to the Alabama hospital this spring because her doctor was concerned about her heart. Rich knew her bones wouldn’t withstand a fall, so she worried about walking around too much.

“I’ll break up like peppermint candy,” she said.

But the hospital staff didn’t give her a choice. They urged her to eat meals while sitting in a chair, get herself dressed and get up as often as possible.

“The more time you spend out of this bed, the healthier you’ll be,” Viles told her.

Despite staying active in the hospital, Rich, a great-grandmother, became more sedentary over the next several weeks. Her daughter, Debra Rich-Horn, said her mother continued to walk when she first came home, but soon she could barely get out of bed.

She died in May.

“Her heart was already at a bad stage,” Rich-Horn said. “By the time [the hospital] got her, it was too late.”

Anna Gorman wrote this “Diagnosis: Unprepared” series for Kaiser Health News supported by a fellowship from New America Media, the Gerontological Society of America and the Common-wealth Fund. KHN’s coverage of geriatric care also has helped from the Scan and John A. Hartford foundations.

This article originally published in the August 22, 2016 print edition of The Louisiana Weekly newspaper.