Hospitalism: Causes, Symptoms & Treatment

Hospitalism can take several forms. In the past, it was also called deprivation syndrome and summarizes all negative psychological or physical long-term consequences of a stay in a home or hospital. Fundamentally, however, hospitalism is caused by inadequate care in above-designated institutions.

What is hospitalism?

In medicine, the term hospitalism summarizes various negative sequelae of long-term hospitalization. Alternatively, hospitalism is referred to as, for example, emotional frustration syndrome or separation syndrome. Depending on the symptoms that occur, a distinction can be made between physical and psychological hospitalism; possible symptoms of physical hospitalism include, for example, regression of the muscles, restrictions in mobility or thrombosis (blood clotting). Symptoms of psychological hospitalism may include depressive moods, stereotyped movements (such as rocking or swaying with the upper body), or autoaggressions (aggressive actions against oneself). Hospitalism can occur regardless of age. For example, people of any age can be affected after prolonged hospitalization. Likewise, however, hospitalism is also found in some children or elderly people who are or have been placed in children’s homes or nursing homes.

Causes

Possible causes of hospitalism are varied and differ depending on the symptoms that occur. Physical hospitalism is most often caused by faulty or inadequate nursing interventions during the storage/prolonged placement of an individual. For example, in bedridden patients, physical damage can be caused by infrequent physical repositioning, lack of hygienic measures, and/or lack of physiotherapy exercises. Psychological hospitalism is usually caused by factors such as a lack of emotional attention, a lack of occupational activities, and a lack of auditory and visual stimulation (such as through music, colors, or pictures). Open rejection by caregivers can also promote mental hospitalism.

Symptoms, complaints, and signs

The symptoms of hospitalism are varied and extensive. They can vary from case to case. The age of the affected person is also decisive. Particularly common are mental disorders such as anxiety, depression, suicidal ideation, borderline personality disorder, passive mood, apathy, lack of self-confidence, autoaggressive behavior, and resignation. Mental disorders often result in disturbances in social behavior. Affected persons develop attachment anxiety, adjustment and communication disorders, and may be prone to aggressive behavior and poor personal hygiene. Sensory disorders such as altered or delayed pain perception, fear of contact or hypersensitivity are also possible. Cognitive disorders are common. Affected individuals often have learning disorders, but also perceptual disorders. Rarely, memory lapses or even loss of long- or short-term memory may occur. Also, in many cases, affected individuals show motor disorders such as monotonous movements and stereotypies (for example, banging their head against the wall) or severely reduced responsiveness. Another symptom of hospitalism can be impaired wound healing due to bed confinement. Affected children also experience developmental delays (for example, short stature or even cognitive deficits) and increased thumb sucking in some cases. They develop a lack of a sense of security and a disturbed sense of basic trust, which can sometimes have a massive impact on the child’s further development.

Diagnosis and course

Hospitalism can be diagnosed, for example, on the basis of typical, occurring symptoms of an affected person and a medical history with at least one prolonged inpatient stay. However, physical hospitalism is usually easier to diagnose because physical symptoms are more clearly attributable to certain influencing factors. A clear link between psychological symptoms and certain influencing factors is usually more difficult.The course of hospitalism is individually different and depends on various factors: For example, the physical/psychological constitution of an affected person, the period of time for which an affected person was/is exposed to the damaging influence and the severity of the symptoms that occur play a role. With early intervention, an almost complete resolution of corresponding symptoms is possible. The course of hospitalism can be more protracted if the affected person has already developed serious psychological/physical sequelae. Here, it is possible that interventions may result in symptom improvement but not complete recovery.

Complications

Hospitalism can result in a wide variety of complaints and symptoms, from which the patient may die in the worst case. The death occurs in many cases when treatments and care are performed with a low standard of hygiene and then inflammation and infection occur. The affected person usually suffers from weight loss and loss of appetite. In addition, there are side effects from any medications taken. The patient’s mental state is also affected by hospitalism, resulting in confusion, panic attacks and depression. Due to the lack of movement in the hospital, there is also a muscle atrophy and thus a reduced resilience of the patient. The quality of life decreases considerably due to the discomfort and the affected person feels ill. The psychological condition may also continue to worsen if the underlying disease does not progress positively and cannot be properly cured. Usually, the symptoms disappear relatively quickly if the causes of hospitalism can be treated and removed. Complications occur when there is no treatment. In this case, the patient may continue to die.

When should one go to the doctor?

When symptoms such as loss of appetite, apathy, and personality changes are noticed, medical advice is needed. Hospitalism always occurs in connection with a stay in the hospital. Therefore, when the above symptoms appear, the attending physicians should be consulted. In most cases, the necessary assistance is provided before serious symptoms develop. Should acute symptoms develop, the nursing staff must be informed. In cooperation with the responsible physician, suitable aids can be provided to reduce the suffering of the affected person. If physical symptoms are present, further treatment is required. Any ulcers must be examined and cleaned, and infections require rapid drug treatment. Regardless of whether the patient himself or a caregiver notices these symptoms, immediate medical attention is required. Hospitalism does not usually represent a serious condition, but the patient still needs to be well observed and given medical attention. If the symptoms reoccur after leaving the hospital, it is best to notify the primary care physician immediately.

Treatment and therapy

In order to successfully combat various forms of hospitalism, a first important behavioral measure is primarily to adapt external circumstances to the needs of an affected person. Whether such a change is possible in the previous environment or whether a change to an alternative environment makes sense depends on the individual case. Often, corresponding improvements in the environment of the affected person contribute to the healing process of various symptoms. As a rule, the earlier the necessary interventions take place, the better the treatment success in hospitalism. Therapeutic measures, which take place in a second step, depend on the symptoms present in hospitalism: physical damage and/or functional impairments that have occurred are to be countered individually, for example, with medication or physiotherapeutic measures. Psychological impairments in the context of hospitalism can be positively influenced, among other things, by consistently addressing and occupying an affected person and by creating a stimulating environment (for example, through colors, pictures, texts or sounds in the form of radio, books or television).In addition, if serious complaints of mental hospitalism have developed as a result of prolonged neglect, longer-term psychotherapeutic interventions may be necessary.

Outlook and prognosis

Recovery from hospitalism in its psychiatric manifestations depends greatly on the duration of hospitalization as well as the age of the affected patient. Although a short-term deprivation can also trigger symptoms of hospitalism, they usually disappear more quickly than after a long stay in hospital or a similar institution. Adult patients are also more resilient, while children and especially infants and young children can suffer sensitive psychological damage. Nowadays, fortunately, great care is taken to enable young patients in particular to have regular and intensive contact with their parents and to give them the attention they need, also through the nursing staff, in order to keep the symptoms of hospitalism to a minimum from the outset. Hospitalism cases associated with abuse have particularly long recovery trajectories. These are often criminal cases where the individual has been locked up in isolation for long periods of time. In these cases, hospitalism can progress to Kaspar Hauser syndrome, which is considered the most severe form of hospitalism. The physical manifestation of hospitalism, nosocomial infection, is a serious complication. When infected with hospital germs, antibiotics usually no longer help, so the patient’s immune system must cope with the infection itself. Such infections are not infrequently fatal if the patient is in poor health.

Prevention

Hospitalism can often be prevented by providing need-based care or nurturing to protected patients. The development of psychological hospitalism in infants, for example, who have to spend long periods in hospital after birth for medical reasons, can often be prevented by early and regular physical contact with caregivers. Preventive measures against psychic hospitalism often include a stimulating and appreciative environment.

Aftercare

In hospitalism, aftercare depends on how severe the condition is. Mild hospitalism usually subsides on its own once the patient receives the necessary affection. After a few days to weeks, the family doctor should be consulted again. The physician can perform a physical examination and, if necessary, prescribe an appropriate medication. In the case of severe hospitalism, therapeutic treatment is usually necessary. After completion of therapy, the patient must maintain an active, full lifestyle. Since there is often a fear of hospitals, suitable alternatives must be sought. Before a new hospital stay, the affected person should talk to the therapist. It may be necessary to take sedatives or antidepressants. Affected infants need permanent maternal attention. This can be achieved by placing the sick child in a foster family or by the parents establishing an intimate relationship with the child as part of mother-child therapy. Nowadays, hospitalism rarely occurs, which is why a targeted therapy must always be carried out with regard to the respective physical, mental and emotional complaints. In the case of severe hospitalism, placement in a specialized facility may be necessary.

What you can do yourself

To treat hospitalism, the first step is to adjust the external circumstances of the affected person. If possible, the patient should be transferred to more suitable accommodation and must be cared for there individually and in relation to his needs. Accompanying this, the resulting psychological and physical impairments must be treated. Which measures have to be taken in detail depends entirely on the respective complaints. Physiotherapy is usually recommended, as physical exercise is an important therapeutic tool. Psychological complaints are also alleviated by regular occupation with the affected person, accompanying the therapeutic treatment. Daily conversations as well as practicing hobbies or mere contact with friends and family members can already considerably alleviate hospitalism.The patient’s environment should be made appealing, whether through pictures, colors or sounds in the form of radio, books, television or other employment opportunities. If hospitalism occurs after the patient has left the hospital or nursing home, he or she will also need care and attention. In less severe cases, hospitalism resolves on its own and the patient is fit again after a few weeks to months. In any case, a physician must be informed of the symptoms.