Accelerometry Assessed Physical Activity of Older Adults Hospitalized with Acute Medical Illness - an Observational Study

Abstract

Background: In a hospital setting and among older patients, inactivity and bedrest are associated with a wide range of negative outcomes such as functional decline, increased risk of falls, longer hospitalization and institutionalization. Our aim was to assess the distribution, determinants and predictors of physical activity (PA) levels using wrist-worn accelerometers in older patients hospitalized with acute medical illness.Methods: Observational study conducted from February to November 2018 at an acute internal medicine unit in the University hospital of Lausanne, Switzerland. We enrolled 177 patients aged ≥65 years, able to walk prior to admission. PA during acute hospital stay was continuously recorded via a 3D wrist accelerometer. Clinical data was collected from medical records or by interview. Autonomy level prior to inclusion was assessed using Barthel Index score. PA levels were defined as <30 mg for inactivity, 30-99 mg for light and ≥100 for moderate PA. Physically active patients were defined as 1) being in the highest quartile of time spent in light and moderate PA or 2) spending ≥20 minutes/day in moderate PA.Results: Median [interquartile range - IQR] age was 83 [74-87] years and 60% of participants were male. The median [IQR] time spent inactive and in light PA was 613 [518-663] and 63 [30-97] minutes/day, respectively. PA peaked between 8 and 10 am, at 12 am and at 6 pm. Less than 10% of patients were considered physically active according to definition 2. For both definitions, active patients had a lower prevalence of walking aids and a lower dependency level according to Barthel Index score. For definition 1, use of medical equipment was associated with a 70% reduction in the likelihood of being active: odds ratio (OR) 0.30 [0.10-0.92] p=0.034; for definition 2, use of walking aids was associated with a 75% reduction in the likelihood of being active: OR=0.24 [0.06-0.89], p=0.032.Conclusion: Older hospitalized patients are physically active only 10% of daily time and concentrate their PA around eating periods. Whether a Barthel Index below 95 prior to admission may be used to identify patients at risk of inactivity during hospital stay remains to be proven.

Association between antihypertensive combinations and postoperative mortality and functional decline: a nationwide survey of Japanese adults undergoing major surgeries

“…A plausible explanation for its underlying pathological mechanism is the suppression of angiotensin II-induced impairment in protein synthesis, acceleration of protein breakdown, and loss of appetite. Angiotensin II increases the levels of cytokines and systemic hormones, including reactive oxygen species, insulin-like growth factor 1, tumor necrosis factor alpha, interleukin-6, and transforming growth factor beta [7][8][9][24][25][26][27][28]. The current study showed that among patients who used a single class of antihypertensive, those who used RASi had lower odds for the composite outcome of mortality and functional decline than those who used TH.…”

“…The primary outcome was the composite of overall inhospital death and decline in physical function, which was defined as a 5-point lower Barthel Index score [24] at discharge than at admission. Patients were followed up until discharge, transfer, or inhospital death.…”