Last Updated on April 7, 2025 by Analgesia team
Hospital-associated deconditioning
Hospital-associated deconditioning (HAD) is a broad term that refers to any decline in bodily function resulting from a hospital stay. It can include a loss of muscle mass, cognitive decline, and other physiological changes. HAD can significantly impact a patient’s quality of life and well-being after they leave the hospital.
Hospital-associated deconditioning |
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What it is |
A condition of physical, psychological, and functional decline that occurs as a result of complex physiological changes caused by prolonged bed rest and associated loss of muscle strength,
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Who it affects |
Older people, especially those with frailty, are at greatest risk
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What it can include |
Loss of muscle mass, cognitive decline, tendon stiffening, reduced bone density, incontinence, and increased dependency
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How can it impact patients? |
Patients are at an increased risk of institutionalization, repeat hospitalizations, and susceptibility to ill health events
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Some interventions that can help reduce HAD include:
Behavior change techniques
- Goal-setting: Establishing realistic, personalized goals — such as standing up for meals or walking to the bathroom — helps patients feel a sense of progress and ownership over their recovery.
- Performance feedback: Regular, positive feedback from staff (e.g., “You walked further today than yesterday!”) reinforces effort, builds confidence, and motivates further activity
- Prompting and reminders: Visual cues, schedules, or verbal reminders can nudge patients to move regularly.
- Social support: Involving family members or peers in encouraging movement can boost morale and compliance.
Daily activities
Encouraging patients to sit up, get out of bed, and get dressed can help them stay independent and maintain muscle strength.
- Sitting upright for meals: Helps maintain core strength and digestion, while also signaling a return to normalcy.
- Getting out of bed regularly: Prevents muscle atrophy, reduces the risk of pressure injuries, and supports circulation and respiratory function.
- Getting dressed in regular clothes: Reinforces a sense of identity and independence, rather than reinforcing the “sick role” that comes with hospital gowns.
Exercise classes
Structured movement can be adapted for all levels of ability, including frail or elderly patients:
- Chair-based exercises: Safe for patients with limited mobility; includes seated leg lifts, arm raises, and stretches that engage multiple muscle groups.
- Modified group sessions: Tailored programs that offer social interaction, light resistance training, and cardiovascular activity adapted to inpatient needs
- Benefits: These exercises can reduce feelings of isolation, improve mood and appetite, stimulate circulation, and help maintain strength and flexibility.
Early intervention strategies can help reverse the effects of HAD, but the long-term effects can be devastating. We also have a dedicated post on how to prevent deconditioning syndrome in older adults.