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Purpose To examine distinct mobility outcomes (locomotor capacity, physical activity, life-space mobility) of acute geriatric care (AGC) in acutely hospitalized older adults and identify predictors associated with these outcomes. Methods The PAGER study was designed as a prospective observational study. Mobility outcomes of 107 hospitalized older patients (age = 83.2 ± 6.4 years, female: n = 68, 63.6%) receiving AGC were measured at hospital admission and discharge. Locomotor capacity was assessed with the Short Physical Performance Battery (SPPB), 24-h physical activity (step count) with an activity monitor, and life-space mobility with the Life-Space Assessment in Institutionalized Settings (LSA-IS). Baseline demographical, clinical, physical, cognitive, and psychological characteristics were analyzed as candidate predictors of mobility outcomes. Results SPPB (median [interquartile range] 4.0 [2.8–5.0] pt. vs. 5.0 [3.0–6.3] pt.), step count (516 [89–1806] steps vs. 1111 [228–3291] steps), and LSA-IS total score (10.5 [6.0–15.0] pt. vs. 16.3 [12.0–24.1] pt.) significantly improved during AGC (all p < 0.001). Adjusting for baseline status, frailty was identified as an independent negative predictor of SPPB, step count, and LSA-IS at discharge (p = 0.003–0.005). Barthel Index was also independently positively associated with step count (p = 0.017) at discharge, as was the mean daily PA level with SPPB (p = 0.027) at discharge, both independent of baseline status. Conclusion AGC improves distinct mobility outcomes in hospitalized older patients. Frailty was consistently found to be an independent negative predictor of all mobility outcomes. Frailty assessment in AGC may be important to identify patients at risk for decreased treatment gains in mobility. Early PA promotion in AGC seems to be beneficial in improving patients’ locomotor capacity.
Purpose To examine distinct mobility outcomes (locomotor capacity, physical activity, life-space mobility) of acute geriatric care (AGC) in acutely hospitalized older adults and identify predictors associated with these outcomes. Methods The PAGER study was designed as a prospective observational study. Mobility outcomes of 107 hospitalized older patients (age = 83.2 ± 6.4 years, female: n = 68, 63.6%) receiving AGC were measured at hospital admission and discharge. Locomotor capacity was assessed with the Short Physical Performance Battery (SPPB), 24-h physical activity (step count) with an activity monitor, and life-space mobility with the Life-Space Assessment in Institutionalized Settings (LSA-IS). Baseline demographical, clinical, physical, cognitive, and psychological characteristics were analyzed as candidate predictors of mobility outcomes. Results SPPB (median [interquartile range] 4.0 [2.8–5.0] pt. vs. 5.0 [3.0–6.3] pt.), step count (516 [89–1806] steps vs. 1111 [228–3291] steps), and LSA-IS total score (10.5 [6.0–15.0] pt. vs. 16.3 [12.0–24.1] pt.) significantly improved during AGC (all p < 0.001). Adjusting for baseline status, frailty was identified as an independent negative predictor of SPPB, step count, and LSA-IS at discharge (p = 0.003–0.005). Barthel Index was also independently positively associated with step count (p = 0.017) at discharge, as was the mean daily PA level with SPPB (p = 0.027) at discharge, both independent of baseline status. Conclusion AGC improves distinct mobility outcomes in hospitalized older patients. Frailty was consistently found to be an independent negative predictor of all mobility outcomes. Frailty assessment in AGC may be important to identify patients at risk for decreased treatment gains in mobility. Early PA promotion in AGC seems to be beneficial in improving patients’ locomotor capacity.
The purpose of the current quality improvement (QI) project was to implement the UMove Early Mobility Program to engage patients in safe out of bed (OOB) activities and reduce falls, specifically focusing on toileting-related falls, during the hospital stay. Eight nursing units implemented the UMove program, including the UMove Mobility Screen (UMove MS), to select strategies to reduce toileting-related falls while increasing mobility. De-identified, unit-based data were collected from hospital reports. Nursing had a 95% documentation compliance rate for the UMove MS, and OOB activities and ambulation were documented at 50% and 57%, respectively. There was no statistical difference found in reducing toileting-related falls or sustaining increased OOB activities across the 15-month QI project. Toileting-related falls approached significance with a rate reduction from 1.77 pre-implementation to 0.23 at 6 months and no toileting-related falls at 12 months. Despite no significant findings, there is evidence that clinical changes occurred with nurses assessing and promoting mobility, while implementing strategies to reduce toileting-related falls. [ Research in Gerontological Nursing, xx (x), xx–xx.]
Background Function-focused care is an approach used to increase physical activity in hospitalized older adults with dementia. Objective To explore factors associated with participation in function-focused care in this patient population. Methods This was a cross-sectional descriptive study using baseline data from the first 294 participants in an ongoing study on testing function-focused care for acute care using the evidence integration triangle. Structural equation modeling was used for model testing. Results The mean (SD) age of the study participants was 83.2 (8.0) years, and the majority were women (64%) and White (69%). Sixteen of the 29 hypothesized paths were significant and explained 25% of the variance in participation in function-focused care. Cognition, quality of care interactions, behavioral and psychological symptoms associated with dementia, physical resilience, comorbidities, tethers, and pain were all indirectly associated with function-focused care through function and/or pain. Tethers, function, and quality of care interactions were all directly associated with function-focused care. The χ2/df was 47.7/7, the normed fit index was 0.88, and the root mean square error of approximation was 0.14. Conclusion For hospitalized patients with dementia, the focus of care should be on treating pain and behavioral symptoms, reducing the use of tethers, and improving the quality of care interactions in order to optimize physical resilience, function, and participation in function-focused care.
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