Promoting Nurse-Led Mobility Protocols for Hospitalized Older Adults: A Systematic Review

Caba, Laura Wolf; Goldin, Deana; Marenus, Michele W.

doi:10.3928/00989134-20220606-04

Cited by 7 publications

(6 citation statements)

References 15 publications

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“…In this study, we observed that hospitalized patients spend a significant proportion of their days at low or middle levels of mobility 26,27 . Current recommendations on fall prevention advocate that the clinical team prioritize promoting safe patient mobility to help avoid complications from prolonged immobility and bed rest 28,29 . We observed a trend that nonfallers spent more time at JH-HLM levels of 7 or 8 representing longer ambulation distances, but we may not have been powered to see the impact of this.…”

Section: Discussionmentioning

confidence: 77%

“…26,27 Current recommendations on fall prevention advocate that the clinical team prioritize promoting safe patient mobility to help avoid complications from prolonged immobility and bed rest. 28,29 We observed a trend that nonfallers spent more time at JH-HLM levels of 7 or 8 representing longer ambulation distances, but we may not have been powered to see the impact of this. Injurious falls are not frequent hospital events, so larger studies are needed to examine the role of keeping patients more mobile to help reduce injurious falls.…”

Section: Discussionmentioning

confidence: 93%

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Association of Longitudinal Mobility Levels in the Hospital and Injurious Inpatient Falls

Hoyer,

Young,

et al. 2023

Am J Phys Med Rehabil

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Falls are one of the most common adverse events in hospitals, and patient mobility is a key risk factor. In hospitals risk assessment tools are used to identify patient-centered fall risk factors and guide care plans, but these tools have limitations. To address these issues, we examined daily patient mobility levels prior to injurious falls using the Johns Hopkins Highest Level of Mobility (JH-HLM), which quantifies key patient mobility milestones from low-level to community distances of walking. We aimed to identify longitudinal characteristics of patient mobility prior to a fall to help identify fallers before the event. Conducting a retrospective matched case-control analysis, we compared mobility levels in the days leading up to an injurious fall between fallers and non-fallers. We observed that patients who suffered an injurious fall, on average, spent 28% of their time pre-fall at a low mobility level (JH-HLM levels 1 to 4), compared to non-fallers who spent 19% of their time at a low mobility level (Mean Absolute Difference: 9%; 95% CI 1% to 16%, p = 0.026; Relative Difference: 44%). This suggests that assessing a patient’s mobility levels over time can help identify those at an increased risk for falls and enable hospitals to manage mobility problems more effectively.

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 93%

Association of Longitudinal Mobility Levels in the Hospital and Injurious Inpatient Falls

Hoyer,

Young,

et al. 2023

Am J Phys Med Rehabil

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“…Without adequate pain control, patients either do not want to or cannot mobilize and participate in rehabilitation therapy. 31 With the aging US population, it is imperative to find ways to better treat these patients so they can return to their acceptable quality of life. Doing so will improve outcomes not only for patients but also for the health care system with reduced costs and overutilization.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Persistent Post-traumatic Headache Remains Significantly High

2024

Topics in Pain Management

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“…Regular physical activity during hospitalization is vital to help patients regain their functional abilities. Without adequate pain control, patients either do not want to or cannot mobilize and participate in rehabilitation therapy 31…”

Section: Discussionmentioning

confidence: 99%

Geriatric Pain Protocol: Impact of Multimodal Pain Care for Elderly Orthopedic Trauma Patients

Andujo,

Yue,

McKelvey

et al. 2024

Topics in Pain Management

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Hip fractures are costly, and associated complications are the leading cause of injury-related deaths in persons 65 years or older. Uncontrolled pain leads to increased hospital length of stay (LOS), delayed physical therapy, and long-term functional impairment. The Geriatric Pain Protocol (GPP) is Cedars-Sinai's multimodal pain management solution, addressing the needs of older adult inpatients who have suffered fractures. Study participants included hip fracture patients admitted between February 1, 2019, and March 5, 2021. Inclusion criteria were patients 65 years or older with a hip fracture sustained from a ground-level fall and surgical candidate. Participants were divided into 2 categories: Geriatric Fracture Program (GFP) and non-GFP, with physician participation in the GFP being the differentiating factor. End points included postoperative pain, postoperative opioid utilization, LOS, complications, and 30-day readmission rates. The GPP decreased morphine milligram equivalent (MME) daily totals on days 1 and 2 and improved pain management compared with non-GPP patients. MMEs were lower in the GPP group than in the non-GPP group for both postoperative day 1 (POD1) (P = 0.007) and POD2 (P = 0.043); the Numerical Rating Scale (NRS) pain score on POD1 was lower in the GPP group (vs non-GPP, P = 0.013). There were no group differences in NRS POD2 pain or complications (all Ps > 0.1). The study sample (N = 453) had no significant difference between sex and LOS (all Ps > 0.3). Although not statistically significant, the 30-day readmission rate trended lower in patients treated in accordance with the GPP. Use of the GPP reduced pain levels and MME totals.

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Promoting Nurse-Led Mobility Protocols for Hospitalized Older Adults: A Systematic Review

Cited by 7 publications

References 15 publications

Association of Longitudinal Mobility Levels in the Hospital and Injurious Inpatient Falls

Association of Longitudinal Mobility Levels in the Hospital and Injurious Inpatient Falls

Prevalence of Persistent Post-traumatic Headache Remains Significantly High

Geriatric Pain Protocol: Impact of Multimodal Pain Care for Elderly Orthopedic Trauma Patients

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