In-Hospital Mobility Variations Across Primary Diagnoses Among Older Adults

Abstract

Objectives To examine the relationship between primary diagnoses and mobility impairment and recovery among hospitalized older adults. Design Prospective cohort study. Setting UF Health Shands Hospital, an 852-bed level I trauma center located in Gainesville, Florida. Participants 18,551 older adults (≥65 years) with 29,148 hospitalizations between 1/2009 and 4/2014. Measurements Incident and discharge mobility impairment and recovery were assessed using the Braden activity subscale score that was recorded by the nursing staff at every shift change–approximately three times per day. Primary diagnosis ICD-9 codes were used as predictors and re-categorized by using the Agency for Health Care Research and Quality Clinical Classification Software. Results Out of the 15,498 hospital records where the patient was initially observed to “walk frequently”, 3,186 (20.6%) developed incident mobility impairment (chair-fast or bedfast). Primary diagnoses with a surgical or invasive procedure were the most prevalent (77.2 %) among the hospital observations with incident mobility impairment; otherwise primary diagnoses without surgery were much more associated with discharge mobility impairment (59%). The highest incidence of mobility impairment occurred in patients with heart valve disorders and aortic and peripheral/visceral artery aneurysms (6.24 and 6.05 events per 30 person-days, respectively); septicemia showed the highest incidence rate for mobility limitation at discharge (0.94 events per 30 person-days). Mobility impairment was observed in 13,650 (46.8% of total) records at admission and 5,930 (43.44%) were observed to recover to a state of walking occasionally or frequently. Osteoarthritis and cancer of gastrointestinal organs/peritoneum had the highest incidence rate for mobility recovery (7.68 and 5.63 events per 30 person-days respectively). Conclusions Approximately 1 out of 5 patients who were mobile at admission became significantly impaired during hospitalization. However, about half (43.4%) of patients observed to have mobility impairment at admission recovered during hospitalization. Conditions most associated with mobility impairment and recovery are varied, but older patients hospitalized for septicemia and cardiovascular diseases with surgery (heart valve disorders and aortic/peripheral/visceral artery aneurysms) appear to be at most risk for incident mobility impairment that did not recover at discharge.

Bisphosphonates Influence and Pain Assessment in Mobilization of Patients with Fragility Fracture of the Pelvis

“…Mobilization assesment was realised in a dynamic way throuh a method used in our hospital since currently there is no standardized method in literature [14]. Recently Valiani try to adapt the Braden mobility subscale [15] but the model shows limitations and was not generalized. In our clinic the mobilization was initiated as early as possible depending on the degree of pain experienced by the patient.…”

Relationship between Time of Day of Medical Emergency Team Activations and Outcomes of Hospitalized Pediatric Patients

“…The Clinical Classifications Software (CCS) was used to present admission diagnoses using the International Classification of Diseases 10th Revision (ICD-10) coding system, which has been used in prior pediatric studies. 12 26 ICD-10 codes were also used to identify patients with complex chronic conditions using the framework established by Feudtner and colleagues. 27…”

High Rate of Medical Emergency Team Activation in Children with Tracheostomy

“…As previously reported and described, 15 the Clinical Classifications Software (CCS) was used to present admission diagnoses using the International Classification of Diseases 10th Revision (ICD-10) coding system. The CCS approach uses ICD-10 codes to allocate patients into 33 groups to facilitate statistical analyses and has been used in similar adult 23 and pediatric studies. 15,24 ICD-10 codes were also used to identify patients with CCCs, using the framework established by Feudtner et al 20,25 The CCC classification system uses ICD-10 codes to identify comorbidities involving 10 organ systems, and has been adapted for use in Canada.…”