Recommendations for older adults’ physical activity and sedentary behaviour during hospitalisation for an acute medical illness: an international Delphi study

Abstract

Background: Immobility is major contributor to poor outcomes for older people during hospitalisation with an acute medical illness. Yet currently there is no specific mobility guidance for this population, to facilitate sustainable changes in practice. This study aimed to generate draft physical activity (PA) and sedentary behaviour (SB) recommendations for older adults' during hospitalisation for an acute medical illness. Methods: A 4-Round online Delphi consensus survey was conducted. International researchers, medical/ nursing/physiotherapy clinicians, academics from national PA/SB guideline development teams, and patients were invited to participate. Round 1 sought responses to open-ended questions. In Rounds 2-3, participants rated the importance of items using a Likert scale (1-9); consensus was defined a priori as: ≥70% of respondents rating an item as "critical" (score ≥ 7) and ≤ 15% of respondents rating an item as "not important" (score ≤ 3). Round 4 invited participants to comment on draft statements derived from responses to Rounds 1-3; Round 4 responses subsequently informed final drafting of recommendations. Results: Forty-nine people from nine countries were invited to each Round; response rates were 94, 90, 85 and 81% from Rounds 1-4 respectively. 43 concepts (items) from Rounds 2 and 3 were incorporated into 29 statements under themes of PA, SB, people and organisational factors in Round 4. Examples of the final draft recommendations (being the revised version of statements with highest participant endorsement under each theme) were: "some PA is better than none", "older adults should aim to minimise long periods of uninterrupted SB during waking hours while hospitalised", "when encouraging PA and minimising SB, people should be culturally responsive and mindful of older adults' physical and mental capabilities" and "opportunities for PA and minimising SB should be incorporated into the daily care of older adults with a focus on function, independence and activities of daily living".

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

“…This was an unexpected finding that reflects high sedentary behavior in geriatric rehabilitation inpatients is independent of setting and from physical activity, 40 which is in line with recent recommendations to focus on both ends of the activity spectrum by creating a physical environment to increase physical activity and additionally emphasizing reducing sedentary behavior. 41 web 4C=FPO Our results are corroborated by a recent pilot study for a randomized controlled trial comparing 9 home-based and 11 hospitalbased acutely admitted patients using a skin patch (physIQ or Vital-Connect) to assess physical activity. 15,42 The median physical activity duration [209 (90) vs 78 (44) minutes/d, P < .01], steps [1820 (3300) vs 159 (508) per day, P < .06], and standing duration [4.8 (1.4) vs 2.7 (1.8) hours/d, P < .01] were all higher in the home-vs the hospital-based group.…”

A systematic review of the physical activity levels of acutely ill older adults in Hospital At Home settings: an under-researched field

“…HaH was defined as 'a service that provides acute, hospital-level care by healthcare professionals in a home context for a condition that would otherwise require acute hospital inpatient care' [1]. An acute inpatient setting was defined as 'a hospital (private or public) providing 24-h care for people who are unwell and had an unplanned admission' [23]. As HaH is designed to treat acute episodes of transient rather than chronic medical illness [5], studies set in non-medical or non-acute environments such as palliative care, respite, rehabilitation, mental health, long-term care or residential nursing home facilities were excluded.…”

“…Hospitalised patients are highly inactive, with acute medical and surgical inpatients spending between 93 and 98.8% of their time sitting or lying [14], and older patients spending as little as 76mins per day in an upright position [15]. Recently published draft recommendations on physical activity for inpatients have emphasised the importance of incorporating opportunities for physical activity into the daily care of older adults to improve clinical outcomes, focusing on function, independence and activities of daily living [16]. However, there are many institutional barriers to physical activity in hospital including lack of staff support, tethering to medical devices, lack of assistive devices, and unfamiliar surroundings, as well as a fear of injury [17].…”

Behaviour change interventions to increase physical activity in hospitalised patients: a systematic review, meta-analysis and meta-regression

“…Due to the low levels of physical activity observed in hospitalised patients and their serious health consequences, strategies to increase physical activity in this group are required. A recent international Delphi study recommended that hospitalised older people minimise time spent sitting and sedentary behaviours as their individual capability allows [ 17 ]. Increasing physical activity is widely understood to be a form of behaviour change, suggesting that behaviour change approaches should be used [ 18 ].…”