Why do older people get weaker in hospital?

How common is loss of function after a hospital stay?

In a study of 2,293 patients aged 70 and over admitted to hospital with medical illnesses, 35 per cent were discharged with worse ability to carry out basic daily activities, such as bathing, dressing and walking, than two weeks before admission 2.

The risk increased with age, from 23 per cent in people aged 70 to 74 to 63 per cent in those aged 90 or over 2. The oldest patients were less likely to recover function lost before admission and more likely to lose function during the stay 2.

How quickly does bed rest weaken muscles?

In a study of 11 healthy older adults with an average age of 67 who stayed in bed for 10 days, knee extensor strength fell by 13.2 per cent, stair-climbing power by 14 per cent and aerobic capacity by 12 per cent, even though they ate a diet meeting protein recommendations 1.

People who are unwell lose strength even faster, because illness, inflammation, poor appetite and medicines add to the effects of inactivity.

Why do hospital stays reduce movement?

Patients may be attached to drips, oxygen or catheters, feel tired or in pain, worry about falling, or be advised to stay in bed. Hospital routines and a lack of space or staff to support walking also limit activity.

Delirium, which is a sudden state of confusion common in older patients, further reduces mobility and recovery.

Can exercise in hospital prevent decline?

In a randomised trial of 297 acutely hospitalised older patients, an individualised exercise programme of two 20-minute sessions a day for five to seven days reversed the decline in daily activities seen with usual care, with a difference of 3.7 points on the Barthel Index 3.

Patients in the usual care group worsened in all activities assessed, while the exercise group showed significant differences in bathing, dressing, grooming, toilet use, transfers, walking and climbing stairs 3.

What can patients and families do?

Sitting out of bed for meals, walking to the bathroom with help if needed, doing simple exercises in bed or a chair, and wearing everyday clothes and well-fitting shoes all encourage movement. Bringing glasses, hearing aids and walking aids from home supports safe mobility.

Families can encourage eating and drinking, help orientate the person to time and place, and ask the team whether it is safe to walk and how much activity is advisable.

What happens after discharge?

Many people continue to recover after leaving hospital, especially with support. Rehabilitation at home or in a rehabilitation unit may include strength and balance exercises, walking practice and help with daily tasks.

Setting small goals, such as walking a little further each day, and gradually returning to usual activities help rebuild strength.

How can older people prepare before a planned hospital stay?

Before planned surgery or treatment, staying as active as possible, practising simple strengthening exercises such as sit-to-stand, eating well with enough protein and treating problems such as anaemia can help people cope better with a hospital stay.

Bringing glasses, hearing aids, dentures, well-fitting shoes, walking aids and a list of medicines supports safe movement and communication. Families can share information about usual routines, memory and mobility with the ward team.

When should families raise concerns?

Tell the care team about sudden confusion, reduced eating or drinking, new difficulty standing or walking, or a fall in hospital.

After discharge, seek advice if the person is not regaining function, is falling, or cannot manage safely at home.

Frequently asked questions