to prevent deconditioning

Hospital Acquired Deconditioning (HAD) has been defined in the literature as a loss of independence in Activities of Daily Living (ADL) following acute hospitalisation. Acute medical and surgical patients in hospital spend >90% of their time sedentary, often completing less than 1000 steps a day*. This inactivity can exacerbate deconditioning which is defined as the condition of physical, psychological and functional decline that occurs as a result of complex physiological changes induced by prolonged bed rest and associated loss of muscle strength.

The impact of deconditioning sets in just 24 hours into a hospital admission with a loss of 2-5% muscle power and 5% reduction in circulatory volume after 1 day of bed rest*. So, we know we need to intervene early in the patients journey to prevent HAD. Alongside the impact on muscle strength and conditioning, bed rest is also associated with increased risk of*:

Pressure injuries
Falls
Chest infections
Aspiration pneumonia
Delirium
Exacerbation of underlying cognitive deficits
Constipation
Incontinence
Urinary Tract Infections
Reduce appetite
Swallow issues
Clots and Deep Vein Thrombosis
Reduced range of movement
Joint stiffness
Loss of independence and function
Poor Psychological Function
Increased Length of Stay
Increased Therapy and Care needs on discharge

So, how do we tackle acute deconditioning? This is where 'Eat, Drink, Dress, Move' or EDDM comes in! EDDM is a holistic and multidisciplinary approach to care that supports patients to actively participate in their recovery by eating well, staying hydrated, getting washed and dressed in day clothes and footwear, and being as active as possible in hospital. TheEDDMproject aims to provide a framework or systematic approach to continuous improvement in order to prevent deconditioning. Find out more on the 'About' page!

Reconditioning is defined as: “The process of restoring normal function following injury, disease, or inactivity.” And as the brilliant Dr Amit Arora has said - this is now the time to move from just ‘deconditioning awareness and prevention’ to establishing ‘reconditioning’ approaches.

There is growing evidence for the effectiveness of complex multi-component interventions that reduce sedentary behaviour and increase daily physical activity through a shared responsibility among staff, culture change, and the robust application of the behavioural sciences.

Eat

Maintain adequate nutrition

Optimise position for eating

Promote social dining

Drink

Maintain adequate hydration

Optimise position for drinking

Promote social dining

Dress

Maintain dignity and identity

Promote social activities

Avoid overuse of hospital gowns

Move

Maintain mobility and function

Promote independence with appropriate tasks

Encourage engagement in movement and activities