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Review
. 2022 Mar;37(3):10.1002/gps.5687.
doi: 10.1002/gps.5687.

Hospital-associated deconditioning: Not only physical, but also cognitive

Yaohua Chen  1   2 , Arianna Almirall-Sánchez  1 , David Mockler  3 , Emily Adrion  1   4 , Clara Domínguez-Vivero  1 , Román Romero-Ortuño  1   5   6
Affiliations
Review

Hospital-associated deconditioning: Not only physical, but also cognitive

Yaohua Chen et al. Int J Geriatr Psychiatry. 2022 Mar.

Abstract

Introduction: Hospital-associated deconditioning (HAD) or post-hospital syndrome is well recognized as reduced functional performance after an acute hospitalization. Recommendations for the management of HAD are still lacking, partly due to a poor understanding of the underlying processes. We aimed to review existing data on risk factors, pathophysiology, measurement tools, and potential interventions.

Materials and methods: We conducted a systematic review from bibliographical databases in English, Spanish and French with keywords such as 'post-hospitalization syndrome' or 'deconditioning'. We selected studies that included people aged 60 years or older. Three researchers independently selected articles and assessed their quality.

Results: From 4421 articles initially retrieved, we included 94 studies. Most were related to risk factors, trajectories and measures, and focused on the physical aspects of deconditioning. Risk factors for HAD included age, nutritional status, mobility, and pre-admission functional status, but also cognitive impairment and depression. Regarding interventions, almost all studies were devoted to physical rehabilitation and environmental modifications. Only one study focused on cognitive stimulation.

Discussion: In the last decade, studies on HAD have mostly focused on the physical domain. However, neurological changes may also play a role in the pathophysiology of HAD. Beyond physical interventions, cognitive rehabilitation and neurological interventions should also be evaluated to improve deconditioning prevention and treatment in the hospital setting.

Keywords: deconditioning; hospital‐acquired functional decline; older persons; post‐hospitalization syndrome; vulnerability.

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Conflict of interest statement

Yaohua Chen discloses no conflicts. Arianna Almirall‐Sánchez discloses no conflicts. David Mockler discloses no conflicts. Emily Adrion discloses no conflicts. Clara Domínguez‐Vivero discloses no conflicts. Román Romero‐Ortuño discloses no conflicts.

Figures

FIGURE 1
FIGURE 1
Preferred Reporting Items for Systematic review and Meta‐Analysis (PRISMA) Flow chart
FIGURE 2
FIGURE 2
Geographic distribution of included articles
FIGURE 3
FIGURE 3
Risk factors associated with hospital‐associated deconditioning
FIGURE 4
FIGURE 4
Mechanisms of hospital‐associated deconditioning: combination of hospitalization factors and individual vulnerability. HAD, Hospital‐associated deconditioning; HPA, hypothalamic‐pituitary‐adrenal
FIGURE 5
FIGURE 5
Predictive tools or clinical features for HAD
See this image and copyright information in PMC

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