Poor mobility in hospitalized adults of all ages

Abstract

Low levels of activity in hospital inpatients contribute to functional decline. Previous studies have shown low levels of activity in older inpatients, but few have investigated younger inpatients (aged <65 years). This observational study measured activity in older (aged ≥65 years) and younger hospital inpatients on 3 wards (medical, surgical, oncology) in a major teaching hospital in Brisbane, Australia, as part of a quality‐improvement intervention to enhance mobility. Using structured behavioral mapping protocols, participants were observed for 2‐minute intervals throughout 4, 4‐hour daytime observation periods. The proportion of time spent at different activity levels was calculated for each participant, and time spent standing, walking or wheeling was compared between age group and wards. There were 3272 observations collected on 132 participants (median, 30 per patient; range, 9–35). The most time was spent lying in bed (mean 57%), with 9% standing or walking. There were significant differences among wards, but no difference between older and younger subgroups. Low mobility is common in adult inpatients of all ages. Behavioral mapping provided measures suitable for use in quality improvement. Journal of Hospital Medicine 2016;11:289–291. © 2016 Society of Hospital Medicine

“I’m not going to walk, just for the sake of walking…”: a qualitative, phenomenological study on physical activity during hospital stay

“…Physical activity is defined as "any bodily movement produced by skeletal muscles that requires energy expenditure" [1]. Low physical activity is identified as a major risk factor for global mortality [2] and, unfortunately, common among hospitalised patients [3,4]. Obviously, patients are hospitalised for surgery or illness which may, for at least a part, explain low-inpatient physical activity.…”

CHERISH (collaboration for hospitalised elders reducing the impact of stays in hospital): protocol for a multi-site improvement program to reduce geriatric syndromes in older inpatients

“…Mobility and engagement patterns will be assessed using activity mapping for an 8 h day-time period (8 am till 4.30 pm) [40]. In this method of systematic sampling, the auditor observes each patient in a room for a 2 min interval, noting the highest level of a hierarchical list of possible positions (lying, sitting, standing, walking) and activities (sleeping, receiving care, self-care, eating, TV/radio, reading/games/craft, talking, exercising) and in whose company (alone, with visitors, with staff) before moving to the next patient room.…”

“…In this method of systematic sampling, the auditor observes each patient in a room for a 2 min interval, noting the highest level of a hierarchical list of possible positions (lying, sitting, standing, walking) and activities (sleeping, receiving care, self-care, eating, TV/radio, reading/games/craft, talking, exercising) and in whose company (alone, with visitors, with staff) before moving to the next patient room. Observations are repeated continuously in a consistent order for the 8 h period and summarised as the average proportion of time spent at each level for each patient [40]. Meal-time processes including patient positioning, meal set-up, assistance, interruptions and estimated meal consumption will be measured by auditing one breakfast, one lunch and one dinner on the ward using a structured observation sheet, summarising observations using proportions or averages across all patients [41].…”

Towards improving hospital workflows: An evaluation of resources to mobilize patients

“…The benefits of mobilizing patients are well studied. Hospitalized patients of all ages are at risk of functional decline from bed rest and limited mobility (Mudge et al, 2016). Low mobility is a significant predictor of decline in activities of daily living (ADLs), new institutionalization at discharge, and death in older hospitalized patients (Brown, Friedkin, & Inouye, 2004).…”