PYJAMA paralysis: A lot is being written and discussed recently about this ‘condition’

Prevention of such ‘dependency’ has always been the key objective of the medical speciality called 'geriatrics'. Frail elderly individuals admitted to hospital as medical emergency must be rehabilitated back on their feet prior to discharge back home. Sadly this is no longer happening in many cases. And the very expensive acute hospital beds are remaining ‘occupied’ with such patients. Hence this sudden outcry, as if something very new has just been discovered which would resolve the bed crises.

A stepwise approach to the care of acutely ill frail elderly individuals has always been accepted, practised and fully implemented in good health care institutions. This had always been the clinical practise in Bolton too.

No one questions the need for post operative 'recovery' beds which are a pari passu of surgical operations — supported by well trained nursing staff and associates. Although post operative care has been revolutionised with the introduction of day surgery, key hole surgery etc — the principle of ‘recovery and rehabilitation’ after any big procedure is still accepted and fulfilled

Curiously when it affects the frail elderly, usually living alone, those principles somehow vanish. On principle all such monitoring and appropriate care plans exist but it seems, the over all supervision and decision-making seem to be lacking somewhere. Of course everyone is doing his/her job but the result is 'pyjama paralysis.'

Unlike most younger and fitter patients, older ones take longer to recover from any illness; a minor fall may ground them for several weeks. And bed is always bad for older people. When there is an acute shortage of care staff, leaving the person in a bed is the easiest option. Getting a dependent person up and dressed take time, so the easy solution is to leave them in bed in their bed clothes ie pyjamas or nighties. No question asked, no objection raised, the frail patient remains in bed or perhaps on a chair for days or even weeks. Equally dangerous for developing pressure sores

Similar picture exists through out the care scene — the recent report on nursing/care home is equally concerning. Care home inspectors from Healthwatch are quite critical of what they find in many homes; dependent frail individuals lying or sitting in their night clothes — no attempt or staff or time to dress them properly and get them out of bed and perhaps to mobilise them a little.

The basic principle of elder care is being severely compromised; the staff working are not appropriately trained and if ‘trained’ won’t work for such a meagre salary — many are from overseas without any knowledge or training in the care of the old. We do not see 'untrained' individuals in post operative recovery wards or in children’s units.

I am not making any political statement or comment — I am making an attempt to raise the issue once more. Out of the three most important facets of health business,prevention, cure and care — care happens to be the most difficult and expensive as it can only be delivered by trained personnel who are expensive both fiscally and socially. Our attempt therefore must be not to allow people to become dependent and frail in the first instance; everything possible must be done to get such people properly diagnosed, medically treated and fully assessed by a multidisciplinary rehabilitation team for necessary action to avoid ‘pyjama paralysis’.That would be good for both the patients and the exchequer.