We all want to stay as independent as possible as we age, enjoying a simpler lifestyle and being both wiser and calmer. We hope for the ability of doing daily tasks such as walking, bathing and dressing. These are called “activities of daily living” (ADLs) by healthcare professionals. Not being able to perform these basic tasks endangers our independence.

As the body ages, we are more vulnerable to acute demands and stressors and the body has less energy reserve. We can adjust our lives to minimize many excessive demands but sometimes life sends us demands that exceed our reserves.

One such severe demand on our reserves is hospital admission. Doctors have known for some time¹ that when a person is hospitalized, they are at high risk of experiencing a loss of ability to perform ADLs. However, sometimes we must go to the hospital to get care for acute events such as a fracture, stroke or chronic diseases.

While the disease or accident is stressful enough, a stay in the hospital can add additional stress. For example:

• The hospital environment is fast-paced.
• We may have little control over our activity while there.
• We could be released from the hospital with less physical strength and decreased ability to perform ADLs.
• As we age, we may need more assistance and time to recover from a hospitalization.

Hospital Admission and Readmission: Hazardous to Independence
One recent study, funded by the National Institute on Aging and performed by Yale University², has some startling findings about the importance of hospital admissions and readmissions for the elderly. The research identified a strong association between the negative effects of hospital ad-missions and especially negative effects of multiple admissions within a year. Such admissions and readmissions caused older patients with mild disability to rapidly progress to more severe frailty and disability and not be able to perform ADLs. Other factors (including diagnoses) that could worsen disability were accounted for in the research.

The conclusion—hospital admission and readmission can be hazardous to independence.

In addition, a person’s everyday functioning is one of the strongest predictors of mortality among the elderly. The study suggests “aggressive efforts are warranted to minimize the adverse func-tional consequences of acute hospital admissions.” After discharge there is need to “enhance re-storative interventions in care at home, nursing homes and other outpatient settings.”

Recommendations include access to interdisciplinary palliative care teams, which includes

• symptom management,
• support for family and caregivers,
• serious discussions about your wishes for both advanced care planning and
• what care is needed to prevent the likelihood of subsequent hospital admissions.

This study found that hospices (which have such interdisciplinary palliative care teams) were not able to have a meaningful effect on readmissions because most Medicare patients in the study were referred to a hospice too late. Such care is needed much sooner and some hospitals are forming palliative care teams to provide care for complex, elderly patients.

How to Stay Independent
What should you do to insure your longest and best possible independence in ADLs? Plan ahead.

1. Make careful decisions. If you must be admitted to a hospital in the future, make very careful decisions about which level of care is most appropriate and consistent with your personal preferences, goals and prognosis. Foster good communication between you, your family, caregivers, doctors and other clinicians.
2. Plan for the future. You should choose a person to be your decision maker in case you are not able to communicate. You need an “advanced directive”, also known as a living will, which includes your decision maker’s information and your personal wishes about your hospital care. Be sure to communicate your wishes, that your providers have a copy of your advance directive and that you are not discharged from the hospital without proper plans to ensure recovery.

Get Involved
Hospitals across the nation are forming teams to prevent hospital admissions and readmissions. In Tennessee, atom Alliance has helped form the Upper Cumberland Transitions of Care Community, which brings together healthcare agencies and professionals that meet monthly to solve issues and develop ways to serve patients better. Many other communities exist across the five-state atom Alliance, and they welcome your participation.

Go here to find a community near you, and learn more about how atom Alliance is working with healthcare providers in Alabama, Indiana, Kentucky, Mississippi and Tennessee to keep people with Medicare out of the hospital.

Bio: Bernice Wilson O’Roark MSN, is a former nurse, former nursing educator and executive, former hospice director, and the retired founding Executive Director of the Ohio Hospice Organization. In her ‘retirement’ she has served as Executive Director of Trailview Development, developer of the innovative ElderSpirit Community in Abingdon, Virginia. ElderSpirit was the first elder co-housing community in the USA and was designed for elders to own and control their community of mutual support and spirituality during later life.

A community leader in middle Tennessee and member of Upper Cumberland Transitions of Care Community, she serves on boards and is President of SilverSpirit, consulting with organizations and groups interested in making a significant difference in the lives of seniors.

¹ Disability in Older Adults: Evidence Regarding Significance, Etiology, and Risk by LP Fried and JM Gurainik Journal American Geriatric Society January 1997
² The Role of Intervening Hospital Admissions on Trajectories of Disability in the Last Year of Life: Prospective Cohort Study of Older People by Thomas M Gill et al. British Medical Journal 20 May 2015.