Rethinking Hospital-Associated Deconditioning: Proposed Paradigm Shift

Abstract

Physical therapists often treat older adults with marked deficits in physical function secondary to an acute hospitalization. These deficits are often collectively defined as hospital-associated deconditioning (HAD). However, there is a paucity of evidence that objectively demonstrates the efficacy of physical therapy for older adults with HAD. Older adults with HAD represent a highly variable and complex population and thus may be difficult to study and develop effective interventions for using our current rehabilitation strategies. This perspective article outlines an innovative framework to operationalize and treat older adults with HAD. This framework may help therapists apply emerging exercise strategies to this population and facilitate additional research to support the total value of physical therapy for older adults in postacute care settings-with value measured not only by improvements in physical performance but perhaps also by reduced rates of disability development, rehospitalization, and institutionalization.

Figure 1.

Differing trajectories leading to a loss of functional reserve in older adults. HAD=hospital-associated deconditioning.

Figure 2.

Current rehabilitation hierarchy for older adults with hospital-associated deconditioning (HAD) and hierarchy of an updated treatment approach for older adults with HAD. RT=resistance training, ADL=activities of daily living, GCAs=general conditioning activities.