Accelerometer‐Measured Hospital Physical Activity and Hospital‐Acquired Disability in Older Adults

Abstract

BACKGROUND: Hospital-acquired disability (HAD) is common and often related to low physical activity while in the hospital. OBJECTIVE: To examine whether wearable hospital activity trackers can be used to predict HAD. DESIGN: A prospective observational study between January 2016 and March 2017. SETTING: An academic medical center. PARTICIPANTS: Community-dwelling older adults, aged 60 years or older, enrolled within 24 hours of admission to general medicine (n = 46). MAIN MEASURES: Primary outcome was HAD, defined as having one or more new activity of daily living deficits, decline of four or greater on the Late-Life Function and Disability Instrument (calculated between baseline and discharge), or discharge to a skilled nursing facility. Hospital activity (mean active time, mean sedentary time, and mean step counts per day) was measured using ankle-mounted accelerometers. The association of the literature-based threshold of 900 steps/day with HAD was also evaluated. RESULTS: Mean age was 73.2 years (SD = 9.5 years), 48% were male, and 76% were white. Median length of stay was 4 days (interquartile range [IQR] = 2.0-6.0 days); 61% (n = 28) reported being able to walk without assistance of another person or walking aid at baseline. Median daily activity time and step counts were 1.1 h/d (IQR = 0.7-1.7 h/d) and 1455.7 steps/day (IQR = 908.5-2643 steps/day), respectively. Those with HAD (41%; n = 19) had lower activity time (0.8 vs 1.4 h/d; P = .04) and fewer step counts (1186 vs 1808 steps/day; P = .04), but no difference in sedentary time, compared to those without HAD. The 900 steps/day threshold had poor sensitivity (40%) and high specificity (85%) for detecting HAD. CONCLUSIONS: Low hospital physical activity, as measured by wearable accelerometers, is associated with HAD. Clinicians can utilize wearable technology data to refer patients to physical/ occupational therapy services or other mobility interventions, like walking programs. J Am Geriatr Soc 68:261-265, 2020.

Recommendations for older adults’ physical activity and sedentary behaviour during hospitalisation for an acute medical illness: an international Delphi study

“…When hospitalised with an acute medical illness, older adults are at high risk of functional decline, newly acquired disabilities and poor outcomes that persist post-hospitalisation such as continued decline, institutionalisation and death [13][14][15]. Research is only beginning to investigate activity dosage in older medical patients with reports of: a reduced risk of 30-day hospital readmission above a threshold of 275 steps per day and further risk reduction for every 100 step increase in mean daily steps [16]; an increased risk of hospital associated functional decline if taking ≤900 steps per day [17,18] and the suggestion that walking at least twice a day for 20 min is associated with less functional decline in people of variable physical capabilities [19]. The problems of low mobility and SB in hospitals are complex because there are system issues, in addition to challenges relating to people, culture, the environment and operational processes [20].…”

Individual Responsiveness to Physical Exercise Intervention in Acutely Hospitalized Older Adults

“…The sedentary lifestyle that characterizes hospitalized older adults could contribute to the marked functional decline that they usually suffer, particularly during long hospital stays. Indeed, different studies have reported that hospitalised older adults spend most of the time in bed even when they are able to walk independently [31,32], with the levels of inactivity being related to the risk of HAD [10]. Increasing activity levels should therefore be a priority, especially in those patients with a better functional status at admission, with the latter theoretically allowing to maintain a more active lifestyle during the whole hospital stay.…”

“…In this context, although a number of factors can increase the risk of HAD [7][8][9], lack of physical activity during hospitalization seems particularly important. A recent study reported a mean daily non-sedentary time-that is, excluding sitting or lying in bed-of only one hour in hospitalized older adults, which in turn was associated with a greater HAD risk [10]. Strong evidence supports the beneficial role of in-hospital exercise programs to attenuate functional decline in older patients [11][12][13].…”

Sedentary Behaviour in Hospitalised Older People: A Scoping Review

“…Some of these include functional decline and increased frailty [ 2 ], resulting in hospital-acquired disability (HAD) [ 3 ]. One main reason for HAD is sedentary behaviour (SB) [ 4 ], which has been shown to result in increased loss of muscle mass and function [ 5 , 6 ]. The effects of SB during hospital admission persist post-discharge [ 7 ], with previously active older people more sedentary at home post-discharge as a result of HAD [ 8 ].…”