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Multiple Stressors Contribute to Readmission Within 30 Days

Sleep deprivation, poor nutrition, pain and discomfort contribute to post-hospital syndrome

WEDNESDAY, Jan. 9 (HealthDay News) -- Nearly one-fifth of Medicare patients discharged from the hospital are readmitted within 30 days, which seems to arise from a combination of factors contributing to patient vulnerability, according to research published in the Jan. 9 issue of the New England Journal of Medicine.

Harlan M. Krumholz, M.D., of the Yale University School of Medicine in New Haven, Conn., examined post-hospital syndrome, an acquired transient period of vulnerability noted in the 30-day period after discharge when patients seem to experience a period of generalized risk for various adverse health events.

According to the report, about one-fifth of Medicare patients, or 2.6 million seniors, experience an acute medical condition within 30 days of hospital discharge. Common causes of readmission include heart failure, pneumonia, chronic obstructive pulmonary disease, infection, gastrointestinal conditions, mental illness, metabolic derangements, and trauma, and are usually distinct from the initial presenting cause. Post-hospital syndrome may result not only from physiological changes but also due to sleep deprivation, disrupted rhythms, poor nutrition, pain and discomfort, and the potentially stressful information overload associated with meeting with different health care professionals during their hospital stay.

"Comprehensive strategies for mitigating post-hospital syndrome and its accompanying risks might begin with efforts to target the stressors that probably contribute to vulnerability in patients soon after discharge," Krumholz writes. "We should more assertively apply interventions aimed at reducing disruptions in sleep, minimizing pain and stress, promoting good nutrition and addressing nutritional deficiencies, optimizing the use of sedatives, promoting practices that reduce the risk of delirium and confusion, emphasizing physical activity and strength maintenance or improvement, and enhancing cognitive and physical function."

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