How can hospital associated disabilities be reduced?

Almost one million people are hospitalised once a year in Switzerland, half of whom are over 65 years old (Federal Statistical Office, 2021). 50% of patients with 21 or more days of hospitalisation are hospitalised up to four times within two years (Federal Statistical Office, 2021), with an average length of stay of 5.3 days.

In view of demographic trends (Federal Statistical Office, 2021), hospital admissions of elderly and chronically ill patients will continue to increase in the future, both throughout Switzerland and at the University Hospital Basel (USB). This will increase the potential for long-term patients and multiple admissions and highlights the increased need for efficient and effective treatment methods for the corresponding population. In addition, because the corresponding population can be associated with an increase in costs (Berry-Millett & Bodenheimer, 2009; Motzek et al., 2017). Initial data from Switzerland shows that around 17.5 % of patients no longer regain their functional status on discharge from hospital, which may be the reason for the problems described above (D'Onofrio et al., 2018). Older hospitalised patients in particular have a pre-existing risk of poor functional outcome in the areas of ability to act and function and/or complications acquired during hospitalisation, known as HAD (Loyd et al., 2020). If these functional limitations are not recovered, this can lead to a "post-hospital syndrome", an increased vulnerability of older patients after hospitalisation. At the centre of this is the risk of developing a further medical problem within three months (Krumholz, 2013), which leads to re-admission to hospital in around 20 % of cases (Dharmarajan & Krumholz, 2015). The figure below (Figure 1) illustrates the cycle described above.

One of the triggering factors that can lead to HAD is lack of exercise. Lack of exercise among hospitalised patients is a common problem that often causes complications and impairs recovery. As general fitness and activity are not the responsibility of a specific professional, physical fitness and activity are not systematically recorded and patients are usually not encouraged to undertake the necessary activity. The prevalence of inactivity and its negative impact on the recovery process emphasises the urgency of promoting and monitoring physical activity during hospitalisation. The preliminary findings from the observation of the movement behaviour of patients in the USB, in which an average of 88.4% of the time was spent lying down or sitting, confirm the need for such an approach.