Low Mobility During Hospitalization and Functional Decline in Older Adults

Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel.
Journal of the American Geriatrics Society (Impact Factor: 4.57). 02/2011; 59(2):266-73. DOI: 10.1111/j.1532-5415.2010.03276.x
Source: PubMed


To examine the association between mobility levels of older hospitalized adults and functional outcomes.
Prospective cohort study.
A 900-bed teaching hospital in Israel.
Five hundred twenty-five older (≥70) acute medical patients hospitalized for a nondisabling condition.
In-hospital mobility was assessed using a previously validated scale. The main outcomes were decline from premorbid baseline functional status at discharge (activities of daily living (ADLs)) and at 1-month follow-up (ADLs and instrumental ADLs (IADLs)). Hospital mobility levels and functional outcomes were assessed according to prehospitalization functional trajectories. Logistic regressions were modeled for each outcome, controlling for functional status, morbidity, and demographic characteristics.
Forty-six percent of participants had declined in ADLs at discharge and 49% at follow-up; 57% had declined in IADLs at follow-up. Mobility during hospitalization was twice as high in participants with no preadmission functional decline. Low versus high in-hospital mobility was associated with worse basic functional status at discharge (adjusted odds ratio (AOR)=18.03, 95% confidence interval (CI)=7.68-42.28) and at follow-up (AOR=4.72, 95% CI=1.98-11.28) and worse IADLs at follow-up (AOR=2.00, 95% CI=1.05-3.78). The association with poorer discharge functional outcomes was present in participants with preadmission functional decline (AOR for low vs high mobility=15.26, 95% CI=4.80-48.42) and in those who were functionally stable (AOR for low vs high mobility=10.12, 95% CI=2.28-44.92).
In-hospital mobility is an important modifiable factor related to functional decline in older adults in immediate and short-term (1-month follow-up) functional outcomes.

Download full-text


Available from: Nurit Gur-Yaish, May 03, 2014
87 Reads
  • Source
    • "Various measures of physical function have been shown to predict rehospitalization and survival in patients with HF. Decreased mobility in hospitalized patients is associated with adverse outcomes like functional decline [9, 10], new institutionalization, and death [9]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background. Heart failure (HF) is a prevalent chronic condition where patients experience numerous uncomfortable symptoms, low functional status, and high mortality rates. Objective. To determine whether function and/or symptoms predict cardiac event-free survival in hospitalized HF patients within 90 days of hospital discharge. Methods. Inpatients (N = 32) had HF symptoms assessed with 4 yes/no questions. Function was determined with NYHA Classification, Katz Index of Activities of Daily Living (ADLs), and directly with the short physical performance battery (SPPB). Survival was analyzed with time to the first postdischarge cardiac event with events defined as cardiac rehospitalization, heart transplantation, or death. Results. Mean age was 58.2 ± 13.6 years. Patient reported ADL function was nearly independent (5.6 ± 1.1) while direct measure (SPPB) showed moderate functional limitation (6.4 ± 3.1). Within 90 days, 40.6% patients had a cardiac event. At discharge, each increase in NYHA Classification was associated with a 3.4-fold higher risk of cardiac events (95% CI 1.4-8.5). Patients reporting symptoms of dyspnea, fatigue, and orthopnea before discharge had a 4.0-fold, 9.7-fold, and 12.8-fold, respectively, greater risk of cardiac events (95% CI 1.2-13.2; 1.2-75.1; 1.7-99.7). Conclusions. Simple assessments of function and symptoms easily performed at discharge may predict short-term cardiac outcomes in hospitalized HF patients.
    02/2014; 2014:815984. DOI:10.1155/2014/815984
  • Source
    • "This situation could be improved by improving the triage of older patients presenting to the ED,(18) along with providing further education of medical students and emergency room staff about the normal processes of aging and aged-related health issues.(2) The outcomes for hospitalized older patients could be further improved within the hospital by applying a multidisciplinary multicomponent approach to help ensure early mobilization(30) and aggressive prevention of falls and delirium.(28,29) "
    [Show abstract] [Hide abstract]
    ABSTRACT: older adults are sometimes hospitalized with the admission diagnosis of failure to thrive (FTT), often because they are not felt safe to be discharged back to their current living arrangement. It is unclear if this diagnosis indicates primarily a social admission or suggests an acute medical deterioration. The objective of this study was to explore the level of acuity and medical investigations commonly conducted among older hospitalized adults with a diagnosis of FTT. We conducted a retrospective cohort study at three hospitals in Calgary, Alberta. Data were extracted from the electronic medical records of the 603 admissions of patients 65 years or older with a diagnosis of FTT between January 2010 and January 2011. Markers of medical acuity were evaluated. The vast majority of patients had short hospital stays. Specialist physicians were consulted for 323 cases (54%). Allied health-care professionals were consulted in 151 cases (25%). While in hospital, patients underwent extensive investigations, including CT scans, ultrasounds, and echo-cardiograms. Many patients received IV fluids (71%) and IV antibiotics (35%). The data suggest that acute illnesses, and not social factors, were the primary reason for admission among those given a diagnosis of FTT.
    06/2013; 16(2):49-53. DOI:10.5770/cgj.16.64
  • Source
    • "Additionally, they are at increased risk for functional decline (Covinsky et al., 2003; 2011; Gill et al., 2010; Wilson et al., 2012; Boltz et al., 2013), cognitive loss (Makris et al., 2010), higher resource consumption, and higher rates of readmission (Jencks et al., 2009; US Department of Labor, Bureau of Labor Statistics, 2012). There has been an increasing international awareness that a misalignment of the social, physical, and care environment with the complex needs of older adults may be responsible for many of the negative outcomes associated with hospitalization (Brown et al., 2004; Steinman & Hanlon, 2004; Boltz et al., 2010a; 2011; Parke & Chappel, 2010; Zisberg et al., 2011). In response, models of geriatric care have emerged, with the intention of promoting a better older person-hospital environment fit and improving the outcomes and experiences of hospitalization. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Nurses Improving Care of Healthsystem Elders (NICHE) provides hospitals with tools and resources to implement an initiative to improve health outcomes in older adults and their families. Beginning in 2011, members have engaged in a process of program self-evaluation, designed to evaluate internal progress toward developing, sustaining, and disseminating NICHE. This manuscript describes the NICHE Site Self-evaluation and reports the inaugural self-evaluation data in 180 North American hospitals. NICHE members evaluate their program utilizing the following dimensions of a geriatric acute care program: guiding principles, organizational structures, leadership, geriatric staff competence, interdisciplinary resources and processes, patient- and family-centered approaches, environment of care, and quality metrics. The majority of NICHE sites were at the progressive implementation level (n = 100, 55.6%), having implemented interdisciplinary geriatric education and the geriatric resource nurse (GRN) model on at least one unit; 29% have implemented the GRN model on multiple units, including specialty areas. Bed size, teaching status, and Magnet status were not associated with level of implementation, suggesting that NICHE implementation can be successful in a variety of settings and communities.
    Nursing and Health Sciences 05/2013; 15(4). DOI:10.1111/nhs.12067 · 1.04 Impact Factor
Show more