A systematic review of the physical activity levels of acutely ill older adults in Hospital At Home settings: an under-researched field

Abstract

Purpose The purpose of this review was to identify, evaluate and synthesise existing evidence reporting the physical activity levels of acutely ill older patients in a ‘Hospital At Home’ setting and compare this to patients with similar characteristics treated in a traditional hospital inpatient setting. Functional changes and any adverse outcomes due to physical activity (e.g. falls) in both settings where PA was reported or recorded were also evaluated as secondary outcomes. Methods A search strategy was devised for the MEDLINE, CINAHL, AMed, PEDRO, OT Seeker and Cochrane databases. Search results were title, abstract and full-text reviewed by two independent researchers. Data were extracted from included articles using a custom form and assessed for quality and risk of bias using the Appraisal Tool for Cross-Sectional Studies. Results No studies set in the Hospital at Home environments were identified. 16 hospital inpatient studies met the criteria for inclusion. Older patients managed in inpatient settings that would be eligible for Hospital at Home services spent 6.6% of their day active and undertook only 881.8 daily steps. Functional change was reported in four studies with both improvement and decline during admission reported. Conclusion There is a lack of published research on the physical activity levels of acutely-ill older adults in Hospital at Home settings. This review has identified a baseline level of activity for older acutely ill patients that would be suitable for Hospital at Home treatment. This data could be used as a basis of comparison in future hospital at home studies, which should also include functional change outcomes to further explore the relationship between physical inactivity and functional decline.

Patients’ experiences of being treated for acute illness at home as an alternative to hospital admission: a qualitative study in Denmark

“…However, they found that the same population treated in-hospital spent 6.6% of their day active and performed only 882 daily steps, placing them at an increased risk of functional decline. 16 These results and our findings support the hypothesis that the incidence of posthospital syndrome and ‘pathological inactivity’ is likely to be lower among home-treated patients than in hospitalised patients, and this can potentially impact the patients’ recovery and readmission rates.…”

Geriatric Rehabilitation Inpatients Roam at Home! A Matched Cohort Study of Objectively Measured Physical Activity and Sedentary Behavior in Home-Based and Hospital-Based Settings

“…A recent systematic review seeking to investigate if geriatric inpatients >60 years old receiving acute care in a home-based setting are more active than hospital-based patients identified that there was a complete absence of studies designed to answer this question. 43 The present study, although in the rehabilitation setting, is the first to provide evidence for higher physical activity in homebased geriatric inpatients and thus gives incentive for future research in a larger sample.…”

Perspectives of health professionals on physical activity and sedentary behaviour in hospitalised adults: A systematic review and thematic synthesis

“…4 Even in those who ambulate independently, high sedentary time and low levels of physical activity during hospitalisation is common, [5][6][7] with an estimated 87-100% of time spent sitting or lying in bed 8 and a daily average of only 880 steps. 9 These patterns are similar even in inpatient settings where the purpose of admission is to optimise recovery, such as rehabilitation. Adults and older adults in inpatient rehabilitation are typically inactive [10][11][12][13][14][15][16][17][18][19][20] and have high levels of sedentary time [14][15][16]18,[21][22][23] which are associated with adverse outcomes including functional decline and hospital-acquired disability.…”