Deconditioning refers to the loss of physical, functional, and cognitive abilities that can occur during hospital admission, particularly in older patients with frailty. It can begin within hours of bed rest and is associated with longer hospital stays, increased dependency, and higher rates of discharge to care homes.
Up to 65% of older patients experience functional decline during hospitalisation, much of which is preventable. Preventing deconditioning is therefore a key priority and requires a whole-team MDT approach. This article outlines practical strategies to reduce deconditioning and promote recovery on the ward and is the third in our article series on use of a MDT approach in preventing harm and ensuring best patient care.
Contents
What is Deconditioning?
Deconditioning is a multifactorial process involving:
- Muscle weakness and reduced mobility
- Loss of independence in activities of daily living
- Reduced cardiovascular fitness
- Cognitive decline and increased risk of delirium
Even short periods of immobility can result in rapid muscle loss, particularly in older adults.
Risk Factors for Deconditioning
Patients at highest risk include those with:
- Frailty or advanced age
- Reduced baseline mobility
- Prolonged bed rest or acute illness
- Cognitive impairment or delirium
- Poor nutrition
These patients should be identified early, with a focus on maintaining function throughout admission.
MDT Approach to Preventing Deconditioning
Nursing Team
Nurses play a key role in promoting activity throughout the day.
- Encourage patients to sit out of bed for meals
- Support regular mobilisation (e.g. walking to the bathroom)
- Discourage unnecessary bed rest
- Maintain a safe environment for mobilisation
Physiotherapy and Occupational Therapy
Therapists lead on functional recovery and mobility.
- Assess baseline mobility and functional status
- Provide individualised exercise and mobility plans
- Recommend walking aids and adaptive equipment
- Support safe transfers and independence
Medical Team
Doctors should prioritise maintaining function alongside treating illness.
- Avoid unnecessary bed rest or restrictive instructions
- Review lines, catheters, and monitoring that limit mobility
- Identify and treat contributors such as delirium or infection
- Encourage early mobilisation in daily plans
The “Sit Up, Get Dressed, Keep Moving” Initiative
A key campaign developed at the University Hospital of North Midlands, led by Dr Amit Arora, focuses on simple, consistent actions to prevent deconditioning.
The campaign encourages all staff to promote three core principles:
- Sit up – avoid prolonged lying in bed
- Get dressed – maintain normal daily routines
- Keep moving – encourage regular mobilisation
This initiative has been endorsed by the British Geriatrics Society and adopted across multiple hospitals in the UK and internationally.
It highlights that small, repeated actions by all members of the MDT can significantly improve patient outcomes.
Practical Measures on the Ward
Simple interventions can reduce the risk of deconditioning:
- Encourage patients to get out of bed daily
- Promote walking rather than bed-to-chair transfers where possible
- Support independence with washing, dressing, and toileting
- Ensure walking aids are available and accessible
- Minimise use of catheters and unnecessary monitoring equipment
- Optimise nutrition and hydration
Patients should be encouraged to maintain as much of their normal routine as possible.
Consequences of Deconditioning
Failure to prevent deconditioning can result in:
- Loss of independence
- Increased falls risk
- Prolonged hospital stay
- Increased likelihood of discharge to a care home
These outcomes are often preventable with early and consistent intervention.
Key Principles
- Deconditioning can begin within hours of immobility
- It is common but preventable
- Prevention requires a whole-team MDT approach
- Early mobilisation and maintaining routine are essential
- Small, consistent actions have a significant impact on outcomes
Further Reading
- British Geriatric Society Deconditioning Awareness Guidelines
- Swinnerton E, Price A. Recognising, reducing and preventing deconditioning in hospitalised older people. Nurs Older People. 2023 Apr 3;35(2):34-41. doi: 10.7748/nop.2023.e1396. Epub 2023 Feb 8. PMID: 36751897.
Written by Dr A Sidhu (CT2)
