All combined, the care setting can threaten a previously independent patient's ability to return home. It deprives them of strength, control, and the thinking skills that they had prior to admission.
In an article in the Journal of the American Medical Associationa year ago, Pierluissi and UCSF colleagues Kenneth Covinsky, MD, and C. Bree Johnston, MD, described a kind of syndrome that occurs "even when the illness that necessitated the hospitalization is successfully treated."
How this process unfolds is unclear. But it can be such a serious transformation, a significant loss of strength and muscle mass, the patient may no longer be able to perform basic activities of daily living.
Some efforts in pockets around the country, such as the two ACE units at San Francisco General, seek to fix this problem.
At each of these 10-bed and 12-bed units at San Francisco General, there's a much tighter focus on getting the patient to walk so as not to lose muscle mass. They are encouraged to eat with other patients in a common area and visit with family and friends.
Games such as bingo or afternoon movies on TV are offered "to prevent isolation" Pierluissi says. Falls and hospital-acquired infections have not risen as was feared.