Deconditioning: The Unintended Consequence of Hospitalisation

Deconditioning – or deconditioning syndrome – is the loss of physical, psychological and functional capacity that can occur during periods of illness and inactivity.¹

Hospital-acquired deconditioning (HAD) refers to the decline in physical and functional abilities that occur during a hospital stay. Of note, these are often not directly related to the admitting condition.

This post – Part 1 in our Preventing Hospital-Acquired Deconditioning Series – gives an overview of HAD, including causes, risk factors, and physical, cognitive and psychological effects.

Common causes of HAD

• Prolonged bed rest
• Reduced mobility and functional activity
• Poor nutrition
• Social isolation
• Delirium and cognitive impairment

Who is most at risk?

Although anyone can experience deconditioning, the following groups of people are at higher risk:¹

• Older adults (> 65 years old)
• People living with frailty
• Individuals living with multiple comorbidities
• People with cognitive impairment or dementia
• Patients experiencing prolonged hospital stays

Plus-size patients may also be more susceptible, as reduced mobility, multiple comorbidities and challenges associated with mobilisation and equipment provision can contribute to a more rapid decline in function during hospitalisation. Moreover, deconditioning in plus-size patients can result in sarcopenic obesity (combination of excess body fat with significant loss of muscle mass and strength).

Physical effects

• Loss of muscle mass and strength (acute sarcopenia)
• Reduced mobility and endurance
  • Increased dependence for activities of daily living
  • Higher risk of falls

Cognitive effects

• Delirium (can both cause deconditioning and occur as a consequence)
• Reduced attention and concentration
• Slower mental processing
• Memory difficulties
• Increased risk of long-term cognitive decline

Psychological effects

• Anxiety
• Depression
• Reduced confidence
• Fear of falling
• Social withdrawal
• Loss of independence

Clinical impact

• Delayed recovery
• Longer rehabilitation periods
• Increased care needs on discharge

Impact on healthcare services

• Increased rehabilitation demand
• Delayed discharges
• Greater healthcare costs
• Increased burden on community services and carers

Published evidence

Patients are admitted to hospital to recover from illness or injury, but many leave with new problems caused by HAD: they leave weaker, less mobile and less independent than when they arrived:

• HAD affects 30 – 41% of older adults.²
• In a study of older adults with prolonged hospital stays (>28 days), deconditioning was identified as the final discharge-limiting factor in approximately 30% of patients and as a contributing factor to delayed discharge in 47.4% of patients.³
• During acute hospitalisation, activity levels are often low, with patients spending 83% of time in bed and 12% in a chair.⁴

Why Does HAD occur?

Modern hospitals are designed to diagnose, treat and stabilise acute illness, but recovery involves more than medical treatment alone. When patients spend prolonged periods inactive, opportunities to maintain mobility, independence and normal daily routines can be reduced. Over time, this combination of illness and inactivity can lead to HAD, even when the underlying medical condition is improving.

Why ‘rest’ isn’t always restorative

Rest plays a vital role in recovery, but prolonged inactivity can come at a cost. During a hospital stay, patients often spend far more time in bed than they would at home, as a result of illness, fatigue or treatment requirements. Unfortunately, even a few days of reduced activity can contribute to muscle weakness, reduced mobility and loss of independence.

The challenge is finding the right balance. Patients need sufficient rest to recover from illness, but they also need opportunities to move, restore/maintain function and remain engaged in everyday activities. Recovery isn’t only about getting better medically – it’s also about avoiding the functional decline that can accompany prolonged inactivity.

Conclusion

Deconditioning can be one of the most significant and lasting consequences of a hospital stay. It can affect how patients move, function and live long after their acute illness has been treated. It may ultimately determine whether they can return to their previous life with the same pre-admission baseline level of function.

Part 2 in this series discusses how quickly deconditioning can occur, and the effects on patients.

Part 3 discusses how it can be reduced or prevented.

References

1. Deconditioning hub: Introduction to deconditioning. British Geriatric Society, 2026. Deconditioning Hub: Introduction | British Geriatrics Society

2. Johansen LK et al. Exploring in-hospital mobility practices for geriatric patients: insights from a mixed-method study. BMC Geriatr. 2025:25.

3. Lim SC et al. Factors causing delay in discharge of elderly patients in an acute care hospital. Ann Acad Med Singap. 2006:35:27–32.

4. Arun B, Lewis SHM. Frailty and deconditioning on the acute take. Clin Med (Lond). 2026;26(2):100548.

Authors

Emma Tarpey – National Clinical Specialist & Liz Allan – Clinical Research Manager