Factors Associated with Step Numbers in Acutely Hospitalized Older Adults: The Hospital-Activities of Daily Living Study

Abstract

Objectives: To determine the number of steps taken by older patients in hospital and 1 week after discharge; to identify factors associated with step numbers after discharge; and to examine the association between functional decline and step numbers after discharge. Design: Prospective observational cohort study conducted in 2015e2017. Setting and Participants: Older adults (!70 years of age) acutely hospitalized for at least 48 hours at internal, cardiology, or geriatric wards in 6 Dutch hospitals. Methods: Steps were counted using the Fitbit Flex accelerometer during hospitalization and 1 week after discharge. Demographic, somatic, physical, and psychosocial factors were assessed during hospitalization. Functional decline was determined 1 month after discharge using the Katz activities of daily living index. Results: The analytic sample included 188 participants [mean age (standard deviation) 79.1 (6.7)]. One month postdischarge, 33 out of 174 participants (19%) experienced functional decline. The median number of steps was 656 [interquartile range (IQR), 250e1146] at the last day of hospitalization. This increased to 1750 (IQR 675e4114) steps 1 day postdischarge, and to 1997 (IQR 938e4098) steps 7 days postdischarge. Age [b ¼ À57.93; 95% confidence interval (CI) À111.15 to À4.71], physical performance (b ¼ 224.95; 95% CI 117.79e332.11), and steps in hospital (b ¼ 0.76; 95% CI 0.46e1.06) were associated with steps postdischarge. There was a significant association between step numbers after discharge and functional decline 1 month after discharge (b ¼ À1400; 95% CI e2380 to À420; P ¼ .005). Conclusions and Implications: Among acutely hospitalized older adults, step numbers double 1 day postdischarge, indicating that their capacity is underutilized during hospitalization. Physical performance and physical activity during hospitalization are key to increasing the number of steps

Variations in physical activity and sedentary behavior during and after hospitalization in acutely admitted older medical patients: a longitudinal study

“…After discharge a doubling in uptime was seen. Our findings are consistent with a recent study by Kolk et al [ 57 ], which aimed to measure the number of steps taken per day in hospital and up to one week after discharge in 188 old (+70) acutely hospitalized patients, with Fitbit Flex worn on the wrist. In contrast, their study did not measure the distribution of physical activity and sedentary through the day.…”

Variations in Physical Activity and Sedentary Behavior During and After Hospitalization in Acutely Admitted Older Medical Patients: A Longitudinal Study

“…Another starting point for the effort to increase patients' physical activity during hospitalization could be to encourage physical activity around 10-11 AM, 3 PM, and 5-6 PM, which would be more consistent with their habitual. Our ndings are also consistent with a recent study by Kolk et al [54], which showed a doubling in steps only one day after discharge compared with one day prior to discharge. Presumably, the relatively high level of activity after discharge in our study, with a median of 2207 steps per day after discharge and 2622 four weeks after discharge, indicates that patients' return to their basic routines occurs earlier than expected, our results indicate a recovery of activity the rst week after discharge.…”

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

“…Furthermore, physical activity assessed postdischarge is likely a better determinant of future ADL and IADL trajectories as it is free of the previously mentioned hospitalassociated barriers. Therefore, future studies should incorporate physical activity and sedentary behavior assessment postdischarge, as is being highlighted using data of the Hospital-ADL cohort of acute patients, 48 and include more distant follow-up to evaluate the longterm role of physical activity during and posthospitalization.…”