“I Feel Worn Out, as if I Neglected Myself”: Older Patients’ Perspectives on Post-hospital Symptoms After Acute Hospitalization

Abstract

Impairment in mobility and instrumental activities of daily living was the dominant experience for interviewed patients. This disability was mainly attributed to four main symptoms: fatigue, apathy, unsteadiness while standing, and fear of falling. We propose a tentative model that summarizes the role of posthospital symptoms in the recovery process and the potential syndromes (frailty, posthospital syndrome, palliative symptoms, and sickness behavior) that could underlie these shared symptoms which may act as a conceptual framework for future research. Our study points at the relevance of symptom experiences in functional recovery postdischarge.

The Course of Geriatric Syndromes in Acutely Hospitalized Older Adults: The Hospital-ADL Study

“…Although decreasing over the postdischarge course, prevalence rates remained high postdischarge, which is consistent with previous qualitative results. 14 Taking into account findings of earlier studies that fatigue, fear of falling, 36 and apathy 37 are often present in older community dwellers, it is perhaps not surprising that these syndromes were highly prevalent in our study population. Yet, these conditions are not commonly acknowledged geriatric syndromes and have not been addressed in previous studies on geriatric syndromes in hospitalized patients.…”

“…19 Besides, in qualitative research apathy has been found to be highly present among older patients during the postdischarge period. 14 In the somatic domain, acknowledged geriatric syndromes such as pain, malnutrition, and incontinence were assessed. 3,4 Dizziness was included, because it is often the result of a multifactorial interplay between medical and functional aspects in older individuals, 20e22 and is associated with other geriatric syndromes such as functional decline.…”

“…Fatigue is an important feature of frailty 3,24 and was found to be prominently reported postdischarge among older patients. 14 In the functional domain, functional and mobility impairments and participants' fall risk was assessed. With regard to fall risk, participants were asked whether they had a fall in the past 6 months before hospitalization, and whether they fell during their hospital stay or in the first, second, or third month postdischarge.…”

“…Qualitative research indeed provides indications that symptoms indicative of geriatric syndromes, for example, fatigue, apathy, and fear of falling, are common in the first weeks post-acute hospitalization. 14 However, little quantitative research has been conducted to assess to what extent syndromes remain present, or how likely it is that patients recover during the postdischarge period. Thus far, a single study on care transitions from hospital to skilled nursing facilities, determined that geriatric syndromes remained highly prevalent at different time points, with patients also developing new syndromes during their nursing home stay.…”

How do muscle and bone strengthening and balance activities (MBSBA) vary across the life course, and are there particular ages where MBSBA are most important?

“…Barriers to increasing physical activity in older people post-acute hospitalization include a lack of energy, health problems that they perceive as limiting movement and that few had been advised to be active so it was not important 110 . Older patients views after hospitalization report fatigue, apathy, unsteadiness while standing, and fear of falling, all perceived as effects of the hospital stay itself 111 . This highlights consistent messaging about activity and regular mobilization (through regular sit to stands and walking to help maintain levels of strength and balance) in this population are important.…”