With the increasing proportion of older persons globally, healthcare issues are becoming more complex. Older persons often spend substantial time confined to bed, which leads to physiological deconditioning and increased risk of falls. Fall-related injuries lead to higher hospitalization costs and worsening of the quality of life of older persons. Thus, monitoring of falls and reducing the risk of falls is an increasingly important element of geriatric care. Examined in this chapter will be aspects related to falls induced by immobilization (bedrest confinement). Interestingly, spaceflight-induced physiological deconditioning predisposes astronauts to higher risk of orthostatic intolerance and, consequently, falls. Since bedrest confinement is an established model for studying the deconditioning effects of spaceflight, knowledge drawn from bedrest studies can provide insights into the underlying mechanisms leading to falls in astronauts and in bed confined patients and in particular in bed-confined older persons who are typically dealing with the deconditioning effects of aging.
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With the increasing proportion of older persons in the world, health care issues are becoming more complex and health care delivery more difficult. Acute care for older persons must confront the interaction of pre-existing factors such as sarcopenia malnutrition and/or with the effects of bedrest confinement during hospitalization which poses difficult health care challenges. Heinrich and colleagues (2010) carried out a systematic review and concluded that up to 1.5% of total health care costs arise due to falls and falls-related injuries. Not surprisingly, understanding the underlying mechanisms of falls and how they can be reduced are pivotal issues in geriatric health (Bousquet et al., 2017; Broadbent et al., 2017; Blain et al., 2016).
While a consequence of frailty is falls (and falls related injuries), bedrest confinement during health care treatment per se leads to further deconditioning in older persons, who typically are coping with deconditioning due to aging and thus leave the hospital (or bed confinement) in worse shape than when they began treatment. Therefore, there is a need to understand the negative effects of bedrest confinement on physiological functions (e.g. muscle volume and structure loss, plasma volume loss, etc.) and on the increased risk of falls. Furthermore, falls lead to higher hospitalization cost, including increased nursing and medical staff, greater spending by insurance companies, and worsening of the quality of life of older persons. Thus, it is clear that monitoring of falls and more importantly, reducing the risk of falls is an important element of geriatric care. As the proportion of older persons is increasing globally, there is a need to address this immediately to ensure that both the quality of life and the well-being of our senior citizens is effectively addressed.
Older persons subject to bedrest induced immobilization should receive careful medical and social screening, including risk of falls. Upon discharge, such older persons have enhanced risk of falls and this falls risk should be monitored in the community. Social gerontological guidance should be implemented such as empowering older persons to adopt healthy behaviors to maintain healthy lifestyles (e.g. increased physical activity, nutrition) and community elements related to social care of the older persons should be incorporated.
This chapter discusses the similarities between deconditioning due to the aging process and spaceflight induced deconditioning related to the microgravity of space. Bed confined individuals and in particular older persons who typically spend large amounts of their time (approximately 80%) in hospital confined in bed, experience a deterioration in their physiological functions in a manner similar to that which astronauts` experience. Knowledge learned from spaceflight deconditioning can thus be used to help physiological deconditioning as occurs in bed confined individuals and especially in older bed confined persons who are already subject to physiological changes due to aging. Conversely, understanding the consequences of bed confinement may aid in developing countermeasures to both the deconditioning of space flight and bed confinement. In addition, this chapter aims to present a case for understanding and managing the vulnerability of older people towards falls. As falls often arise due to physiological deconditioning associated with aging and aggravated by bedrest confinement, this chapter will focus on key aspects in integrated care of older persons who are subject to the risk of loss of physical activity and mobility, functional and cognitive decline (FCD), frailty and malnutrition. These factors leading to falls and other risks are magnified by the consequences of health-related bedrest confinement. Specifically, current knowledge will be examined in related to falls in all phases of hospitalization and recovery beginning with the admission phase (including screening), through immobilization care during hospitalization as well as recovery after return to community to support return to enhanced mobility and prevent falls and improve quality of life. It will also provide examples of how strategies and exercise programs used for maintenance of astronaut health in space could also be used for older persons on Earth (“Geriatrics meets Spaceflight!”, Goswami, 2017). That is, how the training programs, along with nutritional supplementation, used by the astronauts can be used for bed confined older persons. The role of exercises, along with nutritional supplementation, during bedrest confinement will be elaborated in detail in this chapter.