Trying to stay out of the hospital is a good goal. But problems that require a hospital visit are sometimes impossible to avoid (surgery or a fall, for example). Even a short hospital stay can be stressful and exhausting.
With all the noise, disorientation, sleep disturbances, and more, a hospital “is not a very restorative environment,” says Deena Goldwater, M.D., Ph.D., an assistant clinical professor at UCLA who specializes in geriatric cardiology. Some people even experience what’s known as “post-hospital syndrome,” which is marked by ongoing health problems and an elevated risk of hospital readmission.
In fact, about 17 percent of Medicare patients have to return to a hospital within 30 days of being discharged, according to a 2019 statistical brief from the Agency for Healthcare Research and Quality. And other research has shown that most of these readmissions aren’t directly related to the original reason for hospitalization.
One of the most effective ways to prevent post-hospital syndrome is to have someone with you to be your advocate and helper, says Karen Schoelles, M.D., vice president for clinical excellence and safety at the ECRI Institute, a nonprofit that promotes evidence-based care.
If no one can fill that role, Goldwater recommends that you ask your primary care doctor to help you find a social worker. If you end up in a hospital without time to prepare, a nurse should be able to connect you with a social worker or care coordinator.
There are plenty of other simple steps you can take to be safer and more comfortable the next time you need to go to the hospital. And they’ll make it less likely you’ll have to return.
Lack of Sleep
A hospital can be a loud and hectic place at all hours, and getting insufficient sleep can lead to slower healing and exacerbate feelings of disorientation. But the following strategies can help you resolve issues that can interfere with rest:
Noise: If earplugs aren’t enough, ask for a bed farther away from the commotion. “If someone’s at risk of delirium or falls and they need to be checked on frequently, the tendency is to put them closer to the nurses’ station,” Schoelles says. “Unfortunately, that may increase the level of noise.”
Schoelles recommends that someone—or a rotation of people—stay awake next to your bed overnight to make sure you don’t put yourself at risk for a fall.
If the nurses know a friend or family member is keeping an eye out, they may agree to move your room farther from their station. And if the beeping of your machines is bothering you, nurses may be able to turn off a lot of the noises in your room, Goldwater says, as long as they’re still beeping remotely.
Light: Stick to your usual sleep pattern as much as possible. Even if you’re tired, sleeping too much during the day will throw off your body’s rhythm.
Open the shades to help you stay awake, says Tammie Michael, D.N.P., a faculty member at the University of Texas Medical Branch at Galveston, who has worked as a medical surgical nurse and studied ways to reduce hospital readmission. At night, ask someone to turn the lights off.
Staff waking you up: In many hospitals, a nurse will wake you up at 3 or 4 a.m. to take your vitals or draw blood for the lab. If you can, seek out hospitals with special units tailored to older adults, where nurses often make sure not to wake patients between, say, 10 p.m. and 6 a.m., Michael says.
Pressure Ulcers (Bedsores)
Pressure ulcers, also known as bedsores, are areas of damaged skin caused by staying in the same position for too long. They can form over the course of a single day and lead to serious infections.
To prevent them, get moving as soon as you can. If you aren’t mobile, ask a staff member whether someone can move or turn you safely in bed, Michael says.
Some patients have post-operative delirium, which can manifest as confusion, cognitive dysfunction, and behavioral changes. While temporary, this condition can last up to six months and is more common in older adults. Recent research has shown that roughly a quarter of adults 65 and older experience delirium during hospitalization.
Patients and family members might misinterpret these symptoms as a new or unrelated illness. Then “they hit the cycle of continuously returning to the hospital,” Michael says. That in turn can make delirium even worse, because being in a hospital can be disorienting.
To help prevent this condition, try to keep familiar objects and people around you at the hospital, and ask about discharge plans, because getting home sooner can help.
Being able to see and hear clearly is also key, so make sure you bring eyeglasses or hearing aids you regularly use, Goldwater says.
Research shows that just a few days of bed rest can cause older adults to lose muscle mass and can contribute to limited mobility.
It’s important to get up as soon as you can, with help if needed, even if it’s just to sit in a chair. If you can, walk the hallways.
Schoelles and Michael have heard many family members say, “She just had surgery. Can’t she rest today?” But, Schoelles says, “it really is in a person’s best interest for staff to get them out of bed.”
There are a few common ways that hospital infections happen.
Catheters can lead to bladder infections, insertion points for IVs can become infected, collapsed lungs or fluid buildup can lead to pneumonia, and hospital employees and visitors can transfer germs to your skin or open wounds. But commonsense steps can help reduce your risk.
When possible, opt for a bedpan or a slow walk to the bathroom over a catheter, Schoelles says. Tell a nurse immediately if you spot redness or irritation around your IV, and make sure the IV is changed regularly.
If your breathing is shallow because of pain, the hospital should provide you with a device called an incentive spirometer, which will encourage deep breathing, Michael says.
Sitting up—if you’re able to—can help prevent fluid from building up in your lungs. Remind anyone touching you or your bed to wash their hands first, and ask visitors to use bleach wipes to clean surfaces.
What You Must Know Before Discharge
Before you leave a hospital, you or a caregiver should make sure a few things are in order.
1. Verify your medicine regimen. Make sure you or your caregiver knows exactly which meds you need to take and when, especially if there’s a change in your regular routine, Schoelles says. Have someone write it all down for you.
2. Schedule follow-up appointments. If you’ve had surgery, make an appointment with your primary care doctor before you leave, Goldwater says. Your surgeon, who will also follow up with you, might zero in on just the surgical site, she says, so you should have your regular provider check everything else.
3. Find any necessary equipment. If you’re going home, ask a nurse about special items you might need to help you recover. For example, you might want to rent a bed that lets you raise the head of it up to about 90 degrees, Michael says. That way, you can sit up without needing someone to lift you. Talk to your insurer and the hospital about how you can rent, borrow, or buy what you need.
4. Stay hydrated. You’ll probably need to eat and hydrate more than you’d prefer to help you heal and prevent bowel obstruction. Ask your doctor whether particular foods will help. If you don’t like water, Michael suggests mixing it with juice or other flavorings to make it more palatable.
Editor’s Note: This article also appeared in the January 2020 issue of Consumer Reports On Health.
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