Describe What Is Meant by the Term Deconditioning and Critically Discuss How the Registered Nurse Can Minimize the Occurrence of Deconditioning in the Older Patient When Admitted to an Acute Health Care Setting.

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There are arguments to support that many older people leave hospital less able to function or mobilise than when they were admitted (de Morton, Keating & Jeffs 2007). This is due to the occurrence of deconditioning, a risk for many elderly patients admitted to an acute hospital setting. Deconditioning refers to the significant decline in the functional ability of patients, and is generally associated with prolonged bed rest and immobility (Kortebein, 2008). The term is used to describe the physiological changes caused by inactivity, with virtually every body system affected (Eliopoulos, 2010), and it also incorporates functional losses in mental status, ability to accomplish activities of daily living (ADLs) and a decrease in muscle mass and strength (Gillis, MacDonald & MacIsaac 2008). Hospitalisation is often the cause of deconditioning, particularly due to the focus on bed rest in order to recover from illness, or the limited mobility resulting from surgery. As some degree of functional decline is inevitable in ageing (Killewich 2006) older people hospitalised in an acute setting are at greater risk of the problems caused by inactivity. This is due to the changes in body composition and function, including sarcopenia, demineralisation, loss of aerobic capacity, loss of vasomotor stability and changes in respiratory function which occur as individuals age (Killewich, 2006). Functional decline of older patients is the leading complication in hospitalisation of the elderly, as the decreased activity associated with bed rest can lead to accelerated bone loss, dehydration, malnutrition, delirium, sensory deprivation, skin breakdown and incontinence (Kleinpell, Fletcher & Jennings 2008). Deconditioning during hospitalisation occurs rapidly in older people, with functional decline from baseline apparent by day two (Kleinpell, Fletcher & Jennings 2008).

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