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: 4.57). 01/2011; 59(1):91-5. DOI: 10.1111/j.1532-5415.2010.03202.x
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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.

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Available from: James S Goodwin, Oct 06, 2015
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    • "Deterioration of lower extremity skeletal muscle function (decreased lean tissue and strength) in the young and older adults is a frequent consequence of reduced physical activity such as during bed rest (Kortebein et al. 2007; Drummond et al. 2012; Dirks et al. 2014). This poor outcome is especially evident for many older adults who experience repeated episodes of low levels of ambulation during acute hospitalizations and recovery from injuries, illnesses or during the course of a disease (Fisher et al. 2011,2013). Furthermore, older adults exhibit poor muscle recovery following disuse-related muscle loss (Suetta et al. 2009,2013). "
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    ABSTRACT: Bed rest-induced muscle loss and impaired muscle recovery may contribute to age-related sarcopenia. It is unknown if there are age-related differences in muscle mass and muscle anabolic and catabolic responses to bed rest. A secondary objective was to determine if rehabilitation could reverse bed rest responses. Nine older and fourteen young adults participated in a 5-day bed rest challenge. This was followed by 8-weeks of high intensity resistance exercise (REHAB). Leg lean mass (DXA) and strength were determined. Muscle biopsies were collected during a constant stable isotope infusion in the postabsorptive state and after EAA ingestion on three occasions: before (PRE), after bed rest (BEDREST) and after REHAB. Samples were assessed for protein synthesis, mTORC1 signaling, REDD1/2 expression and molecular markers related to muscle proteolysis (MURF1, MAFBX, AMPKα, LC3II/I, Beclin1). We found that leg lean mass and strength decreased in older but not younger adults after BEDREST (P<0.05) and was restored after REHAB. EAA-induced mTORC1 signaling and protein synthesis increased at PRE in both age-groups (P<0.05). Although both groups had blunted mTORC1 signaling, increased REDD2 and MURF1 mRNA after BEDREST, only older adults had reduced EAA-induced protein synthesis rates and increased MAFBX mRNA, p-AMPKα and the LC3II/I ratio (P<0.05). We conclude that older adults are more susceptible than young persons to muscle loss after short-term bed rest. This may be partially explained by a combined suppression of protein synthesis and a marginal increase in proteolytic markers. Finally, rehabilitation restored bed rest-induced deficits in lean mass and strength in older adults. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    The Journal of Physiology 07/2015; 593(18). DOI:10.1113/JP270699 · 5.04 Impact Factor
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    • "The association of physical activity during hospitalization with LOS was mainly investigated in elderly populations. For example, an observational cohort study examined the total number of steps in elderly patients hospitalized with acute medical illness and reported that patients with shorter LOS tended to have higher physical activity [8]. A possible association of physical activity with LOS following surgery can be deduced from trials testing the benefit of fast-track approach. "
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    ABSTRACT: The objective was to examine the association of postoperative physical activity with length of stay in patients who received total laparoscopic hysterectomy for benign gynecologic disease. The case group was composed of 70 patients who entered a critical pathway for elective total laparoscopic hysterectomy from 2009 to 2012 and were discharged behind schedule. The control group was selected from patients who were discharged on schedule, and matched to cases using 1:3 ratio propensity score matching. We compared the number of nursing-documented ambulation of the case group with that of control group. Year of surgery, age, body mass index, endometriosis, systemic disease, previous abdominal surgery and current medication were well balanced between case and control groups. The number of patients with nursing-documented ambulation in case group (19%) was not different from that in control group (11%). Postoperative physical activity measured by nursing-documented ambulation was not associated with length of stay in patients who underwent an elective total laparoscopic hysterectomy for benign gynecologic diseases.
    07/2013; 56(4):256-260. DOI:10.5468/ogs.2013.56.4.256
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    • "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. "
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    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(12). DOI:10.1016/j.ijnurstu.2013.04.007 · 2.90 Impact Factor
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