In-hospital low mobility, suboptimal continence care, and poor nutrition account for immediate and 1-month posthospitalization functional decline. These are potentially modifiable hospitalization risk factors for which practice and policy should be targeted in efforts to curb the posthospitalization functional decline trajectory.

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.

Background In-hospital immobility of older adults is associated with hospital-associated functional decline (HAFD). This study examined the WALK-FOR program’s effects on HAFD prevention. Methods A quasi-experimental pre-post two-group (intervention group [IG] n = 188, control group [CG] n = 189) design was applied in two hospital internal medical units. On admission, patients reported pre-hospitalization functional status, which was assessed again at discharge and 1-month follow-up. Primary outcome was decline in basic activities of daily living (BADL), using the Modified Barthel Index. Secondary outcomes were decline in instrumental ADL (Lawton’s IADL scale) and community mobility (Yale Physical Activity Survey). All participants (75.1 ± 7 years old) were cognitively intact and ambulatory at admission. The WALK-FOR included a unit-tailored mobility program utilizing patient-and-staff education with a specific mobility goal (900 steps per day), measured by accelerometer. Results Decline in BADL occurred among 33% of the CG versus 23% of the IG (p = .02) at discharge, and among 43% of the CG versus 30% in the IG (p = .01) at 1-month follow-up. Similarly, 26% of the CG versus 15% of the IG declined in community mobility at 1-month follow-up (p = .01). Adjusted for major covariates, the intervention reduced the odds of decline in BADL by 41% (p = .05) at discharge and by 49% at 1-month follow-up (p = .01), and in community mobility by 63% (p = .02). There was no significant effect of the intervention on IADL decline (p = .19). Conclusions The WALK-FOR intervention is effective in reducing HAFD.

Among patients whose refill records suggested they had 7 days' supply or less on hand, patients in the anticipatory outreach group were more likely than controls to refill a medication within 7 days (26.9% vs 26.3%; OR, 1.03, 95% CI, 1.00-1.06) (Table 2). However, this effect was not consistent across medication types and was most notably observed among patients taking antiseizure medications (29.7% vs 26.1%; OR, 1.20; 95% CI, 1.02-1.41).Discussion | Building strong partnerships between public and private entities is critical to fostering public health resilience within communities, particularly in the face of natural disasters. 3 Such a partnership between the federal government and a large national retail pharmacy chain allowed for the rapid execution of a pragmatic intervention that was associated with small but clear increases in acquisition of chronic medications as Blizzard Jonas approached the Mid-Atlantic region in 2016. Our study has important limitations, including that outreach was provided by a single pharmacy chain, the study had a focus on medication acquisition as opposed to clinical outcomes, and it had smaller sample sizes for analyses by medication type. However, this experience highlights the promise of broader public-private partnerships to leverage retail pharmacies in preparing patients for future natural disasters.

BackgroundThere is growing evidence that mobility interventions can increase in-hospital mobility and prevent hospitalization-associated functional decline among older adults. However, implementing such interventions is challenging, mainly due to site-specific constraints and limited resources. The Systems Engineering Initiative for Patient Safety (SEIPS 2.0) model has the potential to guide a sustainable, site-tailored mobility intervention. Thus, the aim of the current study is to demonstrate an adaptation process guided by the SEIPS 2.0 model to articulate site-specific, culturally based interventions to improve in-hospital mobility among older adults.MethodsSix consecutive phases addressed each of the model’s elements in the research setting. Phase-1 aimed to determine a measurable outcome: steps/d, measured with accelerometers, associated with functional decline. Phase-2 included interviews with key persons in leadership positions in the hospital to explore organizational factors affecting in-hospital mobility. Phases-3 and 4 aimed to identify attitudes, knowledge, barriers, and current behaviors of medical staff (n = 116) and patients (n = 203) related to patient mobility. Phase-5 included four focus-groups with unit staff aimed at developing an action plan while adapting existing intervention strategies to site needs. Phase-6 relied on a steering committee that developed intervention-adaptation and implementation plans.ResultsNine hundred steps/d was defined as the intervention outcome. 40% of patients walked fewer than 900 steps/d regardless of capability. Assessing or promoting mobility did not exist as a separate task and thus was routinely overlooked. Several barriers to patients’ mobility were identified, specifically limited knowledge of practical aspects of mobility. Consequently, staff adopted practical steps to address them. Nurses were designated to assess mobility, and nursing assistants to support mobility. Mobility was defined as a quality indicator to be documented in electronic medical records and closely supervised by hospital and unit management. Preliminary analyses of the “Walk FOR” protocol demonstrates its’ ability to reduce barriers, to re-shape staff attitudes and knowledge, and to increase in-hospital mobility of older adults.ConclusionsThe SEIPS-2.0 model can serve as a useful guide for implementing a site-tailored comprehensive mobility intervention. This process, which relies on local resources, may promise sustainable practice change that may support early effective rehabilitation and recovery.Electronic supplementary materialThe online version of this article (10.1186/s12877-018-0778-3) contains supplementary material, which is available to authorized users.

This study tested a model accounting for worries among 275 adults during the height of the COVID-19 pandemic in Israel. The main hypothesis posited that psychological and instrumental social support will mediate the association between emotional intelligence and worry, controlling for the level of exposure to the virus risk and demographics. The results showed that social support mediated the above association: social support showed a negative association with worries while instrumental support showed a positive one. The results are discussed in light of existing findings and theories.

Maintenance of daily routines is associated with a reduced rate of insomnia in the elderly. Further studies should examine these relations in broader populations with regard to health, functional status, and cultural background.

The concept of routine is ill-defined and seldom used in the field of nursing, despite the promise it may hold for a better understanding of a wide range of health-related issues. This concept analysis offers an integrative view of routine and suggests directions for future research and practice.