Many factors contribute to good health, but three well known ones are healthy diet, exercise and sleep. Common experience suggests that good diet, exercise and sleep are mutually reinforcing. If these habits are good for the normal population, they are even better for people recovering from illness or surgery. There is an often neglected fourth factor: stress reduction. Stress reduction acts synergistically with healthy diet, exercise and sleep. However, stress has been shown repeatedly to be associated with negative health outcomes and higher death rates. And stress may add to the morbidity and mortality associated with hospitalization.
When can I go home?
Hospitals are stressful places. The beds can be uncomfortable and the food less-than-appetizing. The constant noise and traffic in and out of the patient’s room decrease adequate sleep and increase stress. The best way to reduce the stress of being in a hospital is for the patient to go home. Nevertheless, the decision-making process surrounding discharge from acute care hospitals involves several factors in addition to patient preference, including safety considerations and cost concerns. One of the most common questions that hospitalized patients ask their doctors is “when can I go home?”
Stress at home
Even when patients do go home from acute care facilities, the stressors do not disappear altogether. This is true especially for family and loved ones of the discharged patient who take over responsibility for the discharged patient. Caregivers are often asked to perform challenging tasks for which they have no formal training, including helping patients in and out of bed.
Recognizing that post-acute care may be stressful for families as well, the National Health Services of the United Kingdom mandated support for unpaid caregivers as part of the Care Act of 2014. Here in the US, increased utilization of specialized nursing services is relieving stress from patients as well as caregivers.
Patients don’t need the same level of care they required in the hospital, but they still might need help with administration of IV medications, dressing changes and physical and occupational therapy. Home visits by skilled professionals can be an enormous help to caregivers who don’t feel comfortable with medical-related tasks.
Stress and chronic disease
Chronic diseases such as type II diabetes and congestive heart failure introduce their own stressors. Patients suffering from chronic diseases are caught in a vicious cycle. They experience stress as a result of dealing with their illness, and their illness adds to their physical and emotional stress. For many seniors, social isolation compounds the stress associated with chronic illness.
Home visits can substantially relieve the stresses associated with social isolation and chronic illness. A systematic review of the literature highlighted the importance of house calls, though the focus was on visits by physicians. Psychosocial stress is tricky to evaluate, and so most published reviews of the effects of home visits have focused on parameters that are easier to measure, especially hospital readmissions and emergency room visits. Nevertheless, there is a growing body of literature that suggests that home visits have a substantial effect on reducing stress in patients recently discharged from the hospital.
Stress and new babies
There are more data regarding the value of home visits on reducing stress in new mothers, particularly at-risk mothers. It isn’t clear why postnatal home visits have been as successful as they are in terms of reducing stress, but anyone who has had a baby knows coming home from the hospital is stressful. A visit from a knowledgeable professional can go a long way toward reducing that stress.
As more validated questionnaires that measure stress become available, future studies will reveal the true value of home visits on post-discharge stress reduction. In the meantime, the number and variety of treatments that can be delivered at home will continue to increase. The hope is that health-related outcomes will continue to improve and that the stresses associated with coming home from the hospital will continue to decline.