A hospital stay can cost older adults muscle, and walking and protein push back

Key takeaways

• In a study that fitted motion sensors to 45 older hospital patients who had all been walking before they got sick, they spent about 83% of their time lying in bed and less than an hour a day upright¹².
• Studies estimate that about 3 in 10 older patients leave the hospital needing more help with basic tasks such as bathing, dressing or walking, and the share climbs steeply after 85²³⁵.
• In a Spanish trial of 370 patients averaging 87 years old, two exercise sessions a day during the hospital stay improved physical performance, while patients given usual care lost ground on daily tasks⁶.
• In a Swiss trial of 2,088 medical patients at risk of malnutrition, a dietitian’s plan of better meals and supplement drinks went with 7% dying within 30 days, versus 10% on usual care, or about 27 fewer deaths per 1,000¹³.
• Medicare charges nothing for covered home health services, including physical therapy at home, if you’re homebound and need part-time skilled care¹⁵.

In a study published in 2009, researchers led by Cynthia Brown, of the geriatrics division at the University of Alabama at Birmingham, tried something simple. They attached small motion sensors, called accelerometers, to 45 older patients soon after they arrived in the hospital¹.

Every one of them had been walking before they got sick. None had severe memory and thinking problems or delirium¹.

On average, the patients lay in bed 83% of the time, about 20 hours a day. They sat for about three hours and stood or walked for about 55 minutes¹².

That matters because muscle doesn’t fade only in a slow, steady slide as you age. It often drops in sudden steps: pneumonia, a fall, a surgery, a week in a hospital bed. Our article on exercise after illness describes what 10 days of strict bed rest did to healthy volunteers in their 60s.

This guide covers those setbacks: how to keep moving in the hospital, how to eat when you’re sick, and how to rebuild once you’re home. Our article on muscle and aging covers the everyday basics.

About 3 in 10 older patients leave the hospital needing more help

Geriatricians call this hospital-associated disability. You went in able to wash, dress, get up from a bed or chair, toilet, feed yourself and cross a room on foot. You come home unable to manage at least one of those six³.

Estimates vary with the study and the yardstick.

• About 1 in 3 patients over 70, and about half of those over 85, according to a 2011 JAMA article by Kenneth Covinsky and colleagues³.
• 30% of people 65 and older, in a 2020 analysis of 15 studies with 7,375 patients⁵.
• 37%, in a 2023 review of 10 studies. Its authors warned that the true figure may be lower, because some of the disability counted comes from the illness itself rather than the hospital stay⁴.

Age raises the risk sharply. In a 2003 study Covinsky led, the rate climbed from 23% of patients ages 70 to 74 to 63% of those 90 and older².

The stakes are high. In a 2008 study led by Cynthia Boyd of older adults who left the hospital with a new disability, about 4 in 10 died within a year and nearly 3 in 10 were still disabled. Only 3 in 10 got back to where they had been before³⁵.

The illness does part of the damage. But Covinsky’s team also named things the hospital adds: hours in bed, too little food, tubes and lines that tie patients down, and staff doing tasks patients could still do themselves³.

Some people start with higher odds. Older age, trouble walking before the illness, memory problems, depression and delirium all raise the risk²³. One study that followed adults who were in their 70s when it began found that weaker grip strength predicted hospital-associated disability, while the amount of lean muscle didn’t⁵. Strength you build now is strength you bring into the hospital.

“Ten days in bed, ten years of aging” is a slogan, not a measurement

In 2018, Britain’s health services ran a 70-day challenge called #EndPJparalysis. The goal was 1 million patient days in which hospital patients got dressed in their own clothes and kept moving⁷. Professor Brian Dolan started the campaign, and Jane Cummings, England’s top nurse, launched it⁸.

Campaign materials made a striking claim. The Welsh Government’s announcement said 10 days of bed rest could cost people over 80 up to 10 years’ worth of muscle⁷. A hospital newsletter from Shropshire said the same 10 days meant losing 10% of muscle mass⁸.

Those numbers don’t match, and we couldn’t trace either one to a study that measured it that way. Treat them as shorthand for a real problem.

The campaign’s most useful number was a different one. About 60% of immobile patients had no medical reason to be in bed, the Welsh announcement said⁷. A family can often change that.

Moving in the hospital works, even in your late 80s

Three tested approaches stand out.

Exercise twice a day. In a trial at a public hospital in Navarra, Spain, published in JAMA Internal Medicine in 2019, 370 patients with an average age of 87 were assigned by chance to usual care or to two exercise sessions a day⁶. The sessions mixed moderate strength work, balance and walking, tailored to each person⁶.

After about five days, the exercise group gained 2.4 points on a standard test of physical performance, while the usual-care group gained 0.2⁶. On a scale of daily tasks such as dressing and bathing, the exercise group gained about 2 points and the usual-care group lost 5⁶. The researchers saw no harm from the exercise, and hospital stays were the same length⁶.

Supervised walking. In 2023, Veterans Affairs researchers reported on STRIDE, a supervised walking program for patients 60 and older⁹. Eight VA hospitals started it at randomly chosen times between 2017 and 2019⁹.

Afterward, the estimated share of patients discharged to a skilled nursing facility fell from 13% to 8%⁹. By our rough arithmetic, that’s about 50 fewer nursing-facility discharges for every 1,000 hospital stays. Stays didn’t get longer, and falls didn’t rise⁹.

The catch: few eligible patients got walks. Depending on the hospital, documented walks reached between 0.6% and 22.7% of them⁹. That gap is your opening to ask.

The hospital elder life program. Known as HELP, it uses trained staff and volunteers to keep older patients oriented, moving, eating, drinking and sleeping well¹⁰¹¹. Its core pieces include early walking, getting glasses back on faces and hearing aids working, help with eating, and keeping patients drinking enough. A British team adapting HELP proposed handing every patient a drink every two hours unless a clinician advises against it¹⁰.

A 2018 review of 14 studies found that HELP cut the odds of delirium, a sudden state of confusion, by about half. Falls were 42% lower in the three studies that measured them¹¹. Hospitals saved an estimated $1,600 to $3,800 per patient in hospital costs¹¹.

Eating enough while you’re sick protects muscle and may save lives

Too little food was one of the hospital problems Covinsky’s team named³. Nutrition is the other half of muscle protection.

ESPEN, the European society for clinical nutrition, advises older adults to get at least 1 gram of protein per kilogram of body weight a day, adjusted for illness, activity and how well they tolerate food¹². Its starting guide for energy is about 30 calories per kilogram¹². Older hospital patients who are malnourished or at risk should be offered oral nutritional supplements, the drinks often called medical nutrition shakes, the society says¹².

Here’s our arithmetic for a 130-pound (59-kilogram) woman. ESPEN’s floor of 1 gram per kilogram comes to about 59 grams of protein a day. The 1.2 to 1.5 grams per kilogram used in the Swiss trial below comes to about 71 to 89 grams¹²¹³. Our protein article covers the new federal target and food sources.

The strongest trial. The Swiss study, called EFFORT, was published in The Lancet in 2019¹³. It enrolled 2,088 medical patients at eight hospitals, average age about 72, who screened as at risk of malnutrition¹³. Soon after admission, half got a plan set by a dietitian: adjusted meals, enriched food and snacks first, then supplement drinks, which 91% ended up using¹³.

Within 30 days, 23% of the nutrition group had a serious adverse outcome, a combined measure of major problems, compared with 27% of usual-care patients¹³. Deaths were 7% versus 10%. The researchers calculated one death prevented for every 37 people treated, or about 27 for every 1,000¹³.

Swiss public research funds paid for the trial. The lead author disclosed that his institution had earlier received unrelated grants from Nestlé Health Science and Abbott Nutrition, two nutrition companies¹³.

A company-funded trial after discharge. The NOURISH trial gave 652 malnourished hospital patients 65 and older a high-protein drink with HMB, an ingredient its maker promotes for muscle, twice a day starting in the hospital and continuing for 90 days after discharge¹⁴. Each serving held 20 grams of protein¹⁴.

It missed its main goal: the combined rate of rehospitalization or death didn’t differ between groups¹⁴. Deaths alone, a secondary measure, were 4.8% versus 9.7% after 90 days, about 49 fewer per 1,000 by our arithmetic¹⁴. Abbott, which sells the drink as Ensure Enlive, supported the study, and an Abbott medical director was an author¹⁴. Read it as a promising signal from one company-backed trial, not proof.

ESPEN’s advice for supplement drinks is concrete: at least 400 calories and 30 grams of protein a day, continued for at least a month, with a monthly check on whether they’re helping¹². Older adults who break a hip should be offered them after surgery¹².

One more ESPEN point: it advises against weight-loss diets for older adults who are merely overweight, to protect muscle¹². A hospital stay is not the time to cut calories.

A muscle-protection plan for a hospital stay

We built this plan from the trials and guidelines above. Bring it to a planned admission, or give it to the family member at the bedside.

Stage	What to ask	What to eat	What to do
Before a planned stay	“Will a physical therapist see me, and how soon after surgery can I get up?”	Meet your daily protein target in the weeks before	Keep up strength work and practice rising from a chair; pack your glasses, hearing aids, day clothes and sturdy shoes710
Day 1 in the hospital	“Is there a medical reason I need to stay in bed?” and “Can I be screened for malnutrition?”	Ask for help with meals if you need it, and keep a drink within reach10	Sit in a chair for meals if allowed; get dressed in your own clothes7
Each day of the stay	“Does this hospital have a walking program or the Hospital Elder Life Program?”910	Protein foods at every meal; accept supplement drinks if offered1213	Walk with help two or three times a day if your team allows9; ask a therapist for simple strength moves you can do in a chair6
Before discharge	“Can someone check whether I can bathe, dress and walk as well as before?”3	Ask whether to keep using supplement drinks, and for how long12	Get a written activity plan; ask whether you qualify for home health therapy15
First month home	Ask your clinician about outpatient or home physical therapy15	Keep protein high; continue supplements a month or more if you were malnourished12	Walk daily and repeat chair stands; build toward strength training

A script for families. Try something like: “Before she got sick, Mom walked to the mailbox every day. Is there a reason she has to stay in bed? If not, can someone help her walk today?” It names her baseline, asks for the medical reason and requests a specific action.

Home again: Medicare home health and the rebuilding phase

Medicare covers home health care if you need part-time skilled care, such as nursing or physical therapy, and you’re homebound¹⁵. Homebound means leaving home isn’t advised or is hard without help, and you normally can’t leave without great effort¹⁵.

A doctor or another allowed provider must see you in person and order the care, and a Medicare-certified agency must provide it¹⁵. Physical and occupational therapy are covered, and you pay nothing for covered home health services, though Medicare doesn’t cover round-the-clock care¹⁵.

Once therapy ends, the rebuilding is up to you. Strength training works at any age, as our muscle article shows. Our guide for adults over 65 lays out a weekly mix of strength, balance and aerobic work.

Our muscle article also covers protecting lean tissue on a GLP-1 weight-loss drug, and our article on exercise after illness covers moving during and after cancer treatment.

What the evidence shows

Claim	Evidence rating	What it rests on
Many older adults leave the hospital with new trouble doing basic tasks	Strong evidence	Consistent findings across many cohort studies, though estimates range from about 30% to 37% and may run high345
The Hospital Elder Life Program lowers delirium	Strong evidence	14 studies with consistent results11
Exercise during a hospital stay protects function in very old patients	Promising but early	One 370-person trial at a single hospital6
Supervised walking programs keep more patients out of nursing facilities	Promising but early	One VA trial with low program reach9
Dietitian-led nutrition support lowers complications and deaths in at-risk patients	Promising but early	One large, well-run trial; guideline support for supplement drinks1213
An HMB protein drink after discharge saves lives	Promising but early	One company-funded trial that missed its main goal14
Ten days in bed equals ten years of muscle aging	Not enough evidence	A campaign slogan whose versions don’t agree78

Rest is part of healing, and so is getting back on your feet

Natural health has long trusted rest, nourishment and the body’s own drive to recover. Nothing here argues against rest. It argues against confusing rest with lying still for 20 hours a day.

The body heals through use as well as stillness. Muscles, lungs and balance all answer to movement, and the trials above show that even people in their late 80s respond within days⁶. Food first is a natural-health instinct, too, and the best nutrition trial started with ordinary hospital meals made richer¹³.

Hospitals are built around beds, schedules and safety rules. You can respect all three and still ask, every day, what it would take to stand up.

Questions readers ask

The bottom line

A hospital stay can cost an older adult muscle and independence fast, much of it from lying still and eating little. Trials suggest walking, short daily exercise and dietitian-led nutrition protect function, even near age 90.

Go in with a plan. Ask why bed rest is needed, ask for help walking and eating, and ask about home therapy before you leave. Then rebuild at home with the strength habits that work at any age.

Related reading

• Frail 90-year-olds nearly tripled their strength, proof that muscle responds at any age
• Ease back in after a cold, because with long COVID, pushing can backfire
• Who needs the new protein goal of up to twice the RDA
• Exercise after 65 should mix three things, and few older Americans get even two
• What rehabilitation covers, and why so many people skip it

Sources

1. GeriPal (University of California, San Francisco geriatrics blog). “Bedrest as danger of hospitalization” (on Brown CJ, et al., “The underrecognized epidemic of low mobility during hospitalization of older adults,” Journal of the American Geriatrics Society, 2009;57:1660–1665). September 15, 2009. geripal.org
2. Covinsky KE. “Hospitalization Associated Disability for Older Adults: An Update” (presentation slides citing Covinsky KE, et al., J Am Geriatr Soc 2003, and Brown CJ, et al., J Am Geriatr Soc 2009). Advocate Health continuing education, 2023. ce.advocatehealth.org
3. The Center for Health Design. Research summary of Covinsky KE, Pierluissi E, Johnston CB, “Hospitalization-associated disability,” JAMA, 2011;306(16):1782–1793. 2015. healthdesign.org
4. Giacomino K, et al. “Assessment tools and incidence of hospital-associated disability in older adults: a rapid systematic review.” PeerJ, 2023;11:e16036. pubmed.ncbi.nlm.nih.gov
5. Brown CJ. “Hospital-associated disability in older adults: persistent challenges and emerging solutions” (presentation citing a 2020 meta-analysis in J Am Geriatr Soc 2020;68:486–495, Boyd CM, et al., J Am Geriatr Soc 2008;56(12):2171–2179, and Health ABC study findings). Danish Physiotherapy Congress, 2025. fysio.dk
6. Martínez-Velilla N, Casas-Herrero A, Zambom-Ferraresi F, et al. “Effect of exercise intervention on functional decline in very elderly patients during acute hospitalization: a randomized clinical trial.” JAMA Internal Medicine, 2019;179(1):28–36 (PEDro record). search.pedro.org.au
7. Welsh Government. “Campaign encourages patients to get dressed and keep moving.” April 13, 2018. gov.wales
8. The Shrewsbury and Telford Hospital NHS Trust. “Challenge to end PJ paralysis” (staff newsletter). 2018. sath.nhs.uk
9. Hastings SN, Stechuchak KM, Choate A, et al. “Effects of Implementation of a Supervised Walking Program in Veterans Affairs Hospitals: A Stepped-Wedge, Cluster Randomized Trial.” Annals of Internal Medicine, 2023;176(6):743–750 (Duke University record). scholars.duke.edu
10. National Institute for Health and Care Research. “Content review of existing Hospital Elder Life Program protocols” (supplementary material, Programme Grants for Applied Research, RP-PG-0108-10037). NIHR Journals Library. journalslibrary.nihr.ac.uk
11. Hshieh TT, et al. “Hospital Elder Life Program: Systematic Review and Meta-analysis of Effectiveness.” American Journal of Geriatric Psychiatry, 2018;26(10):1015–1033 (PubMed abstract). pubmed.ncbi.nlm.nih.gov
12. Volkert D, Beck AM, Cederholm T, et al. “ESPEN guideline on clinical nutrition and hydration in geriatrics.” Clinical Nutrition, 2019;38(1):10–47 (University of Copenhagen record, ucviden.dk ; recommendations read in a copy hosted by Fresenius Kabi, a nutrition company). hk-fresubin.web01.fresenius.com
13. Schuetz P, et al. “Individualised nutritional support in medical inpatients at nutritional risk: a randomised clinical trial” (EFFORT). The Lancet, published online April 25, 2019, doi:10.1016/S0140-6736(18)32776-4 (copy hosted by Bern University Hospital). doi.org
14. Consultant360. “Supplement Cuts Mortality, Readmission Rates by 50%” (on Deutz NE, Matheson EM, Matarese LE, et al., the NOURISH trial, Clinical Nutrition, 2016). January 18, 2016. consultant360.com ; enrollment, dose and funding details from Abbott’s company press release of the same date, gapna.org
15. Centers for Medicare & Medicaid Services. “Home health services.” Medicare.gov, accessed October 2026. medicare.gov