Post-Hospital Syndrome

Post-hospital syndrome is a period of acquired, transient vulnerability after hospital discharge, in which the stresses of admission (sleep loss, poor nutrition, immobility, pain, medicines and disrupted routine) leave patients at high risk of readmission for conditions unrelated to the original illness.

A large proportion of older adults are readmitted within 30 days, often with a different diagnosis from the index admission.

Pathophysiology. Sleep deprivation, deconditioning, undernutrition, delirium, polypharmacy and physiological stress dysregulate immune, endocrine, cardiovascular and cognitive function. Together these lower resilience for weeks after discharge.

Weakness, fatigue, poor appetite, low mood, confusion, new falls, breathlessness and difficulty with daily tasks in the days to weeks after discharge. Presentation to the emergency department with infection, heart failure, falls or medicine adverse effects is common.

Diagnosis is clinical, based on the time course and on exclusion of a new acute illness. Check vital signs, orthostatic blood pressure, weight, cognition, mood, nutrition, function, medicines (and whether new medicines were started correctly) and the home situation. Order blood tests and imaging only as clinically indicated.

Differential diagnosis.

• Recurrent or inadequately treated index illness.
• Medicine error or adverse effect.
• Hospital acquired infection, pulmonary embolism and delirium.
• Depression and unrecognised cognitive impairment.

Plan discharge early with medicine reconciliation, a clear written plan, and follow up within 7 days. Encourage mobilisation, adequate sleep and nutrition during admission. After discharge, offer home based physiotherapy, medicine review, nutrition support, carer education and a contact for early concerns. Treat modifiable causes of weakness, low mood and cognitive change.

Referral and escalation. Refer high risk patients to a transitional care or community geriatric service.