Deconditioning

The cumulative effects of multiple chronic diseases such as dementia, depression, stroke, osteoarthritis, heart failure, incontinence, respiratory disease, and diabetes mellitus contribute to physical inactivity and disability in older people. Inadequate dietary intake and nutritional deficiencies exacerbate age-related decline in muscle mass. Psychosocial factors—such as the attitudes of older people themselves, and of caregivers and relatives—are also important. For example, an attitude that physical decline is inevitable in old age can lead to a delay in seeking medical attention for treatable problems. The end result is a reduction in functional reserve, which increases the risk of clinically significant decline during intercurrent acute illness. People with increased susceptibility to disability and deconditioning are often described as frail.

Acute illness in older people is often complicated by development of acute confusion (delirium), incontinence, immobility, or instability. Indeed, these may be the presenting features of acute illness—myocardial infarction may present with confusion rather than chest pain. An atypical presentation may result in delayed presentation by the patient and delayed diagnosis and treatment by the doctor and is a predictor of a poor outcome.

Hospitalization of older people may have deleterious effects distinct from the effects of acute illness. The unusual environment and routine of hospitals and complications of polypharmacy and of therapeutic and diagnostic procedures may worsen or precipitate problems like confusion or incontinence. Use of urinary catheters in incontinent patients or treatment of delirium with physical restraints or with sedative medications will exacerbate immobility and functional impairment. Functional dependency may be reinforced if hospital staff are overly concerned about the risk of falls or if they perform, rather than supervise, daily activities. In addition, social networks may disappear during a long illness, and patients may become demoralized and depressed.