By Jennifer Nussbaum, AIA EDAC, Director of Planning
At the recent 2019 Planetree International Conference on Person-Centered Care, I attended a fascinating session, Adapted Approach to the Elderly – a Bottom-Up Implementation Strategy Based on Clients’ Needs, where the presenter discussed iatrogenic decline. Iatrogenic decline is a deterioration in a patient’s health due to medical examination and/or treatment. Iatrogenesis can be caused by a variety of factors, including medication side effects, complications, or anxiety relating to treatment.
Although old age is a risk factor for iatrogenic decline, I had never considered this concept when thinking about hospital stays for our aging population. For example, patients 75 years and older can lose 5% to 7% of muscle mass during a week of bedrest in a hospital. This in turn can lead to post-hospitalization needs such as rehab or extended stays in skilled nursing facilities after discharge.
As consultants to healthcare facilities and systems, knowing about iatrogenic decline reminds us to discuss the expected continuum of care versus what is being provided. The care provided in a facility can have lasting negative effects that were not otherwise planned for when the patient was admitted to the hospital. A conversation about the built environment’s impact on those negative effects should be considered at each facility.
Reducing bedrest time or encouraging a patient to be more active may not be in alignment with their medical or health needs. However, as planners we can help ensure the environment does not hinder staff or the patient’s ability to understand and progress through their care. Understanding iatrogenic decline lets us connect the dots between a market with a larger cohort of the 65+ population and a facility’s needs to provide spaces capable of assisting longer-term needs for patients, which could include rehab space outside of and/or within the patient rooms, activity tracks to keep patients active with goals, or interactive opportunities to keep patients’ minds sharp. Having the conversation about addressing iatrogenic decline is the first step.