Ambulatory Activity of Older Adults Hospitalized with Acute Medical Illness

Division of Rehabilitation Sciences, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA.
Journal of the American Geriatrics Society (Impact Factor: 4.22). 01/2011; 59(1):91-5. DOI: 10.1111/j.1532-5415.2010.03202.x
Source: PubMed

ABSTRACT To describe the amount and patterns of ambulatory activity in hospitalized older adults over consecutive hospital days.
Observational cohort study.
University teaching hospital Acute Care for Elderly (ACE) unit.
Adults aged 65 and older (N = 239) who wore a step activity monitor during their hospital stay.
Total number of steps per 24-hour day. Mean daily steps were calculated based on number of days the step activity monitor was worn.
Mean age was 76.6 ± 7.6; 55.1% of participants were female. Patients took a mean number of 739.7 (interquartile range 89-1,014) steps per day during their hospital stay. Patients with shorter stays tended to ambulate more on the first complete day of hospitalization and had a markedly greater increase in mobility on the second day than patients with longer lengths of stay. There were no significant differences in mean daily steps according to illness severity or reason for admission.
Objective information on patient mobility can be collected for hospitalized older persons. Findings may increase understanding of the level of ambulation required to maintain functional status and promote recovery from acute illness.

Download full-text


Available from: James S Goodwin, Aug 11, 2015
  • Source
    • "Protective or custodial nursing practices and restrictive hospital environments may also exacerbate functional loss (Resnick et al., 2011; Brown et al., 2007). However, it is often the extended periods of bed rest, inactivity and resulting 'low mobility' (Brown et al., 2009), which causes the most significant barrier to mobility, which is loss of muscle mass, strength and fitness (Fisher et al., 2010; Kortebein et al., 2008). Many older adults in hospital will be dependent on others for help with mobility on admission, whilst others will develop mobility dependency during their stay. "
    [Show abstract] [Hide abstract]
    ABSTRACT: AIMS OF THE PAPER: To present a grounded theory of the nursing team involvement in the process of maintaining and promoting the mobility of hospitalised older adults. BACKGROUND: Being able to mobilise is an important determinant of quality of life in late adulthood. However, advancing age is often accompanied by worsening mobility, which may deteriorate further as a result of illness and particularly hospitalisation. Targeted in-patient rehabilitation interventions may have the capacity to maintain and promote older adults' mobility. Some authors suggest that the nursing team may have a central role in such activities. OBJECTIVES: The study set out to describe the involvement of the nursing team in the process of maintaining and promoting the mobility of hospitalised older adults. It also sought to understand how members of the nursing team viewed their work in relation to physiotherapists and in relation to hospital policy on patient handling. DESIGN: Grounded theory provided the philosophical and structural underpinning to the study. SETTINGS: Data collection centred on three clinical settings which included a general rehabilitation ward, a regional spinal injuries unit and stroke rehabilitation ward. PARTICIPANTS: Semi-structured interviews with 39 rehabilitation staff and 61h of non-participant observation comprised the data set. FINDINGS: The nursing team involvement in patients' mobility maintenance and rehabilitation was explained by the core category 'care to keep safe.' This category identified how the nursing team focused primarily on preventing patient problems rather than focusing on rehabilitation goals. A number of contextual factors in the workplace meant that the nursing team found it difficult to engage in activities to support mobility maintenance and rehabilitation. CONCLUSIONS: Significant changes in the micro and macro context for rehabilitation practice are needed to enable the nursing team to engage more fully in the processes of mobility rehabilitation. Nurse-led initiatives which allow the nursing team to take an active role in implementing intentional strategies to maintain and promote mobility should be implemented and trialled for effectiveness.
    International journal of nursing studies 05/2013; 50. DOI:10.1016/j.ijnurstu.2013.04.007 · 2.25 Impact Factor
  • Source
    • "The physiologic effects of low mobility are well known: a decrease in muscle protein synthesis, muscle strength, and lower extremity and whole-body mass (Kortebein et al., 2008). Additionally, low mobility during hospitalisation is associated with increased length of stay (Fisher et al., 2011) and adverse outcomes including deconditioning , long-lasting functional decline and new institutionalisation (Kortebein, 2009; Zisberg et al., 2011). "
    [Show abstract] [Hide abstract]
    ABSTRACT: AIM: To describe fear of falling in hospitalised older adults and its relationship with patient characteristics and physical function and explore patient views of associated factors. BACKGROUND: Functional decline is a common complication in hospitalised older adults, associated with low mobility and physical activity. Fear of falling may contribute to limited mobility and physical activity, and loss of physical function. An understanding of this relationship, as well as contributing factors, may inform the development of safe, function-promoting interventions. DESIGN: combined quantitative and qualitative approach using chart extraction, observation and interviews of older adults. METHODS: (i) correlations and analysis of variance methods; (ii) content and thematic analysis; and (iii) evaluation of convergence, complementarity and dissonance of quantitative and qualitative data. RESULTS: Depressed older persons were more likely to describe fear of falling (r = 0.47, P = 0.002). Fear of falling was associated with the loss of physical function from admission to discharge (F = 7.6, P = 0.009). The participant response to fear of falling was activity restriction vs. self-direction. Participants described the following factors, organised by social-ecological framework, to be considered when developing alternatives to activity restriction: intrapersonal, interpersonal, environmental and policy. CONCLUSION: Fear of falling plays a significant role in restricting physical activity and function. A multifactorial approach may provide a viable alternative to activity restriction, by facilitating self-direction and functional recovery. IMPLICATIONS FOR PRACTICE: Interventions to prevent falls and activities to promote functional mobility are ideally developed in tandem, with attention paid to the physical and social environment. Preventing hospital-acquired disability may require a shift in organisational values around safety, from a soley protective approach to one that reflects an enabling philosophy emphasising independence and self-direction. Such a paradigm shift would demonstrate a valuing not only of the absence of falls but also the preservation and restoration of function.
    International Journal of Older People Nursing 01/2013; DOI:10.1111/opn.12015
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To examine the ambulatory activity of older patients who had a documented fall during hospitalization for acute illness. A retrospective case-control design was used in a pilot study of patients (n=10; ≥65y) who had a documented fall during their hospital stay and matched controls (n=25) who did not fall. Acute care medical/surgical unit. Men and women 65 years and older who wore a step activity monitor while hospitalized. Not applicable. Fall incidents during the hospital stay were documented by the nurse in a standardized patient safety event report in accordance with hospital policy. The number of steps per 24-hour interval, time spent walking, and total number of activity episodes were determined for patients and controls. On average ± SD, patients who fell took 480.3 ± 432.2 steps per hospital day, spent 53.8 ± 36.9 minutes walking, and engaged in 25.8 ± 16.9 episodes of activity. Mean daily steps, time spent walking, and number of activity episodes for patients who did not fall were 680.1 ± 876.0, 50.1 ± 58.6, and 21.6 ± 23.8, respectively. Logistic regression results indicated no association between the fall outcome and mean daily steps (odds ratio=.95; 95% confidence interval, 0.84-1.06). Ambulatory activity among patients who fell varied widely. Mean daily steps, time spent walking, and number of episodes of activity were comparable with matched controls who did not fall. Patient falls were more likely to be associated with cognitive and hospital environmental factors than actual amount of walking.
    Archives of physical medicine and rehabilitation 12/2011; 92(12):2090-2. DOI:10.1016/j.apmr.2011.06.022 · 2.44 Impact Factor
Show more