Post-hospitalization physical deconditioning

Specialty: Geriatrics.

• elderly deconditioning syndrome
• loss of physical capacity post-admission
• hospital-acquired weakness
• post-hospital functional asthenia

Why it occurs

• Prolonged bed rest and forced immobility during an acute hospital admission
• Accelerated loss of skeletal muscle mass (up to 10% in just 3 days of strict rest in the elderly)
• In-hospital malnutrition due to prolonged fasting for diagnostic tests or inadequate diets
• Cumulative effects of sedative drugs, strong analgesics or neuromuscular blocking agents
• Decrease in cardiorespiratory reserve due to prolonged rest (reduction in cardiac output and stroke volume)

Initial workup

Baseline functional assessment compared to the previous situation using the Barthel index or the Katz scale; walking speed in 4 meters; handgrip strength with dynamometry; blood analysis (albumin, prealbumin, complete blood count to rule out post-admission anemia, electrolytes, creatinine, C-reactive protein); control electrocardiogram and echocardiogram if rest cardiomyopathy is suspected.

Standard management

• Cholecalciferol — Vitamin D3, 1000 IU to 2000 IU orally per day to promote the recovery of skeletal muscle strength
• Hyperprotein enteral nutritional supplementation — rich in leucine and arginine, indicated if spontaneous oral intake covers less than 70% of the estimated caloric requirements
• Enoxaparin (40 mg subcutaneously every 24 hours if significant immobility persists at home and there is a high venous thromboembolic risk, adjusting according to renal function).