Deconditioning Syndrome Awareness and Prevention Campaign: why is everyone talking about it?
In my early days as a NHS doctor, I used to see patients being admitted to hospital who I thought would become well enough to go home in 3-4 days. Several days later, I would find them on the wards, sometimes in a worse condition.
I wondered: Why? Was my assessment wrong? Did a new event happen? Was the system inefficient? Why are they still here?
Later, I realised that many of these patients had lost their ability to function at their pre-admission levels and had ‘deconditioned’, resulting in their needed help in activities of daily living. They had become ‘deconditioned’ because they had stopped using their normal abilities in those crucial early days during illness and recovery. It is widely cited that ‘every ten days of bed rest in hospital can lead to the equivalent of ten years of muscle ageing in people aged over 80 years’. Adverse outcomes of unnecessary bed rest can include: reduced muscle strength, increased risk of falls, reduced mobility, de-personalisation, depression, loss of self-confidence and demotivation. These effects can be collectively be termed as “Deconditioning Syndrome”. It can happen in hospitals, in care homes and even in patients’ own homes, if they are not maintaining their functional abilities.
Deconditioning in frail, older people can start within hours of lying on a trolley or bed. Therefore, it is vital to implement preventative measures early, following admission.
Up to 65% of older patients experience decline in function during hospitalisation. Many of these patients could prematurely end up in a care home because of ‘deconditioning’ during a hospital stay.
As practising clinicians we are too familiar with this. In order to address this, in 2013-14, I wanted more therapists on the wards, but this was not possible for a variety of reasons, including a shortage of therapists. Then the penny dropped, this is not only a therapist’s job- it is everyone’s job to encourage patients to ‘Sit up, Get Dressed, Keep Moving’, be they doctors, nurses, healthcare professionals, dinner ladies, porters - everyone should be able to encourage this.
In April 2016, we decided to actively address this across the local hospitals and started to promote, ‘Sit up, Get Dressed, Keep Moving’: Deconditioning Syndrome Awareness and Prevention Campaign. It was launched nationally in presence of NHS England in October 2016 to mark ‘Older Peoples’ Day’. Little did we realise at the time that the campaign would become so popular that within a few days, we had our educational material requested not only from over twenty UK hospitals but also from as far away as Australia, New Zealand and Canada. To date, many more institutions have adopted this campaign in varying forms across numerous hospitals and our original campaign has been endorsed by the British Geriatrics Society.
There was no written plan, policy, approval document or funding to do this but the team knew what they were doing. Our brilliant nurse colleague, Amanda Futers was at the forefront, co-ordinating all efforts. The team from Emergency Care Improvement Program (ECIP) became a great supporter and we joined forces with their #endpjparalysis campaign, which has, to date, already had thirty million impressions on social media. Many more colleagues, both from the NHS and outside, have joined in.
Everyone understands the importance of being active, yet so often, it is not practised in hospital where the emphasis is often on tests and tablets. But for older people, ‘too much medicine’ can have its own challenges. Since being made aware of the campaign to ‘Sit up, Get dressed, Keep moving’, many staff, patients and families have reported similar experiences with their relatives in hospitals and care homes. After all, this simple concept of raising awareness about deconditioning was close to their lives and something they could identify with. It is so simple and cost effective, requiring minimal expense and yielding considerably better outcomes. It works well with staff, patients and families, further enhancing the important patient-staff relationship. It costs a bit of extra in time on the part of an already stretched workforce, but these are things hospitals and carers should be doing anyway, as part of good care, and should not be an optional extra.
The campaign has been supported by British Geriatrics Society, Emergency care Improvement Program and NHS England. Chief Nurse Jane Cummings (NHS England) has been extremely supportive of the campaign in her blog. We call on colleagues to spread the campaign widely, share materials to raise awareness, help staff and patients to prevent deconditioning and help achieve ‘Home First and Home Fast’.
A simple idea has transformed into a phenomenon. Let us turn this into a social movement and make it part of our routine clinical practice.
Dr Amit Arora is a consultant geriatrician at the University Hospital of North Midlands and has served as Chairman of England Council of the British Geriatrics Society