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Get Out of Bed! Please!

Get Out of Bed! Please!

Nov 13, 2017 5 min read


Who is in charge when you get sick? Is it your primary physician? The hospitalists? You?

It should be a collaboration. Your primary physician won't be in charge.  You would hope that he/she would at least know that you are hospitalized.but not always. So what is the problem? There shouldn't be a problem if in fact everyone communicates. That's the problem. Recently had a two daughters who hired us to assist with their 91 year old mother who was in rehab.  This is what happened.  Their mom fell at home, independent living. Prior to going to the hospital was able to dress, eat, bathroom self and mobilize without assistance.  She had a few memory issues so the daughters put in place an aide to come in a few hours each day.  She falls, goes to the hospital and is found to have no fractures or injuries but is diagnosed with the flu.  She doesn't get admitted she is placed into the observation world.  Goes to a unit for 48 hours, given tamiflu and sent off to rehab. Why Rehab? Well she never got out of bed for the 48 hours while hospitalized.

Staying in bed for a long time without regular physical activity can cause many problems.
  • Blood Clots
    • A leg injury, leg surgery, or bed rest may prevent people from using their legs. When the legs are not being used, blood moves more slowly from the leg veins to the heart. Blood clots are more likely to form in this slow-moving blood (see see ). Blood clots sometimes travel from the leg veins to the lungs and block a blood vessel. These clots, called pulmonary emboli, can be life threatening (see ).
    • But blood clots aren't the only problem.  It doesn't take long to get deconditioned when you are over the age of 60 if you stay in bed for days.
  • Depression
    • Many people who stay in bed for a long time become depressed. Having less contact with other people and feeling helpless may also contribute to depression.
  • Pressure Sores
    • When people stay in one position in bed for too long, pressure is put on the areas of skin that touch the bed. The pressure cuts off the blood supply to those areas. If the blood supply is cut off too long, tissue breaks down, resulting in a pressure sore (also called pressure ulcer or bedsore—see see ). Pressure sores can begin to form in as few as 2 hours. Pressure sores are more likely to develop in people who are undernourished or who leak urine involuntarily (are incontinent). Being undernourished makes the skin thin, dry, inelastic, and more likely to tear or break. Being incontinent exposes the skin to urine, which softens it, causing it to break open. Pressure sores usually occur on the lower back, tailbone, heels, elbows, and hips. Pressure sores can be serious, leading to infection that spreads to the bloodstream (sepsis).
    • If people have difficulty moving, staff members periodically change their position in bed to help prevent pressure sores from forming. The skin is inspected for any sign of pressure sores. Pads may be placed over parts of the body that are in contact with the bed, such as the heels, to protect them.
  • Weak Bones
    • When bones do not bear weight regularly (that is, when people do not spend enough time standing or walking), bones become weak and more prone to fractures.
  • Weak Muscles And Stiff Joints
    • When muscles are not used, they become weak. Staying in bed can make joints—muscles and the tissues around them (ligaments and tendons)—stiff. Over time, stiff joints can become permanently bent—called a contracture. A vicious circle may result: People stay in bed because of a disorder or surgery, resulting in weak muscles and stiff joints, which make moving (including standing and walking) even more difficult.
This now creates a need for rehabilitation.  If in fact the patient got out of bed when hospitalized I believe the need for rehab would greatly decrease; at least inpatient.  The responses I hear when I ask why someone can't get out of bed are usually related to a "policy" that physical therapy needs to evaluate. Many hospital don't have physical therapy available on the weekends, and we know that a lot of crisis' happen on a weekend. So does that mean nursing staff/ aides can't take patients out of bed. YES....that's what I've found unless we push the issue with the particular hospital.  98% of our clients go home or back to where they came from that get out of bed while hospitalized.  It's a struggle, it's constant that we need to be there every day to ask if the patient can get out of bed to eat, sit in the chair, walk down the hall.  The excuses are many. The bottom line is that patients over the age of 60 do better if they mobilize and it prevents a myriad of issues if they can even just get out of bed to eat and sit in a chair.

Our advise is to be sure if you are hospitalized or a loved one you make sure they get out of bed.  If the response is that they can't then ask why.  Very few people are not able to get out of bed.

Advocate for yourself and your family as no one else will.  No one is trying to hurt anyone the system is so wrapped up on liability that it prevents what should happen. You will hear "we have a no lift policy so we can't move them" "we need to have physical therapy evaluate the first"; "we don't have staffing" ; "Our staff doesn't move people its not our job" goes on and on...

Speak up it may mean your life or your loved ones life

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