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Association Between Physical Activity Levels in the Hospital Setting and Hospital-Acquired Functional Decline in Elderly Patients.

ABSTRACT: Importance:The effects of in-hospital physical activity (PA) on outcomes among elderly patients has seldom been assessed. Objectives:To assess PA levels among elderly patients hospitalized for acute medical illness and to examine the association between PA levels and functional decline and other clinical outcomes at discharge. Design, Setting, and Participants:This monocentric cohort study was performed among patients 65 years or older who were admitted for acute medical illness to the internal medicine ward of Lausanne University Hospital, Lausanne, Switzerland, from February 1 through November 30, 2018. Data were analyzed from January 1 through December 2, 2019. Exposures:Daytime and 24-hour PA levels assessed via wrist accelerometers and measured in millig units (mG; 1 mG?=?9.80665?×?10-3 m/s2). Mean Outcomes and Measures:Functional decline (defined as a ?5-point decrease in the modified Barthel Index), risk of bedsores, length of stay (LOS), and inability to return home. Results:A total of 177 patients (106 [59.9%] men; median age, 83 [interquartile range, 74-87] years) were included. Lower mean (SD) PA levels were found in patients using walking aids before admission (daytime, 12 [5] vs 15 [7] mG; 24-hour, 10 [3] vs 11 [5] mG), those admitted for a reason associated with functional decline (daytime, 12 [6] vs 14 [7] mG; 24-hour, 10 [4] vs 11 [4] mG), or those prescribed physiotherapy (daytime, 12 [5] vs 15 [7] mG; 24-hour, 10 [4] vs 12 [5] mG). At discharge, functional decline was found in 63 patients (35.6%; 95% CI, 25.6%-43.1%), bedsore risk in 78 (44.1%; 95% CI, 36.6%-51.7%), and inability to return home in 82 (46.3%; 95% CI, 38.8%-54.0%). After multivariate analysis, no association was found between PA levels and functional decline (multivariable-adjusted mean [SE], 13?[1] vs 13?[1] mG for daytime levels [P?=?.69] and 10?[1] vs 11?[1] mG for 24-hour PA levels [P?=?.45]) or LOS (Spearman rank correlation, ??=?-0.06 for daytime PA levels [P?=?.93] and -0.01 for 24-hour PA levels [P?=?.52]). Patients at risk of bedsores had significantly lower PA levels than those not at risk (multivariable-adjusted mean [SE], 12?[1] vs 15?[1] mG for daytime PA levels [P?=?.008]; 10?[1] vs 12?[1] mG for 24-hour PA levels [P?=?.01]). Patients able to return home had significantly higher PA levels than those institutionalized (multivariable-adjusted mean [SE], 14?[1] vs 12?[1] mG for daytime PA levels [P?=?.04]; 11?[1] vs 10?[1] mG for 24-hour PA levels [P?=?.009]). Conclusions and Relevance:In this study, lower in-hospital daytime and 24-hour PA levels were associated with risk of bedsores and inability to return home on discharge. These findings are important given that one-third of elderly patients present with hospital-acquired functional decline.

SUBMITTER: Tasheva P

PROVIDER: S-EPMC7042865 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Association Between Physical Activity Levels in the Hospital Setting and Hospital-Acquired Functional Decline in Elderly Patients.

Tasheva Plamena P Vollenweider Peter P Kraege Vanessa V Roulet Guillaume G Lamy Olivier O Marques-Vidal Pedro P Méan Marie M

JAMA network open 20200103 1

<h4>Importance</h4>The effects of in-hospital physical activity (PA) on outcomes among elderly patients has seldom been assessed.<h4>Objectives</h4>To assess PA levels among elderly patients hospitalized for acute medical illness and to examine the association between PA levels and functional decline and other clinical outcomes at discharge.<h4>Design, setting, and participants</h4>This monocentric cohort study was performed among patients 65 years or older who were admitted for acute medical il ...[more]

PMID: 32003817

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Project description:BackgroundHospital-acquired disability (HAD) is common and often related to low physical activity while in the hospital.ObjectiveTo examine whether wearable hospital activity trackers can be used to predict HAD.DesignA prospective observational study between January 2016 and March 2017.SettingAn academic medical center.ParticipantsCommunity-dwelling older adults, aged 60?years or older, enrolled within 24?hours of admission to general medicine (n = 46).Main measuresPrimary outcome was HAD, defined as having one or more new activity of daily living deficits, decline of four or greater on the Late-Life Function and Disability Instrument (calculated between baseline and discharge), or discharge to a skilled nursing facility. Hospital activity (mean active time, mean sedentary time, and mean step counts per day) was measured using ankle-mounted accelerometers. The association of the literature-based threshold of 900 steps/day with HAD was also evaluated.ResultsMean age was 73.2?years (SD = 9.5?years), 48% were male, and 76% were white. Median length of stay was 4?days (interquartile range [IQR] =?2.0-6.0?days); 61% (n = 28) reported being able to walk without assistance of another person or walking aid at baseline. Median daily activity time and step counts were 1.1 h/d (IQR = 0.7-1.7 h/d) and 1455.7 steps/day (IQR = 908.5-2643 steps/day), respectively. Those with HAD (41%; n = 19) had lower activity time (0.8 vs 1.4 h/d; P = .04) and fewer step counts (1186 vs 1808 steps/day; P = .04), but no difference in sedentary time, compared to those without HAD. The 900 steps/day threshold had poor sensitivity (40%) and high specificity (85%) for detecting HAD.ConclusionsLow hospital physical activity, as measured by wearable accelerometers, is associated with HAD. Clinicians can utilize wearable technology data to refer patients to physical/occupational therapy services or other mobility interventions, like walking programs. J Am Geriatr Soc 68:261-265, 2020.

Project description:BACKGROUND:In some European countries, including France, older patients with functional decline in acute units are transferred to geriatric rehabilitation units. Some patients may not benefit from their stay in a geriatric rehabilitation unit and paradoxically worsened their functional status. Previous prognostic models of functional decline are based on only baseline parameters. However, some events can occur during rehabilitation and modify the association between baseline parameters and rehabilitation performance such as heart failure episode, falls or hospital-acquired infection (HAI). The incidence of functional decline in these units and factors associated with this decline have not been clearly identified. METHODS:We used a prospective cohort of consecutive patients aged ?75?years admitted to a geriatric rehabilitation unit in a French university hospital. The main endpoint was functional decline defined by at least an one-point decrease in Activities of Daily Living (ADL) score during the stay. Baseline social and geriatric characteristics were recorded and comorbidities were sought by the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). During follow-up, hospital-acquired infection (HAI) was recorded, as was ADL score at discharge. Multivariate logistic regression and mediation analyses were used to identify factors associated with ADL decrease. RESULTS:Among the 252 eligible patients, 160 (median age 84?years [interquartile range (IQR) 80-88] had available ADL scores at baseline (median score 7 [IQR 4-10]) and at discharge (median 9 [6-12]). Median CIRS-G score was 11 [8-13], 23 (14%) had a pulmonary HAI; 28 (17.5%) showed functional decline. On multivariable analysis, functional decline was associated with comorbidities (global CIRS-G score, P?=?0.02, CIRS-G for respiratory disease [CIRS-G-R] ?2, P?=?0.02, or psychiatric disease, P?=?0.02) and albumin level?<?35?g/l (p?=?0.03). Significant associations were found between functional decline and CIRS-G-R (OR 3.07 [95%CI 1.27-7.41], p?=?0.01), between functional decline and pulmonary HAI (OR 3.12 [1.17-8.32],p?=?0.02), and between CIRS-G-R and pulmonary HAI (OR 12.9[4.4-37.7], p?=?0.0001). Theses associations and the reduced effect of CIRS-G-R on functional decline after adjusting for pulmonary HAI (OR 2.26 [0.83-6.16], p?=?0.11) suggested partial mediation of pulmonary HAI in the relation between CIRS-G-R and functional decline. CONCLUSION:Baseline comorbidities were independently associated with functional decline in patients hospitalized in a geriatric rehabilitation unit. Pulmonary HAI may have mediated this association. We need to better identify patients at risk of functional decline before transfer to a rehabilitation unit and to test the implementation of modern and individual programs of rehabilitation outside the hospital for these patients.

Project description:IntroductionExercise and physical activity (PA) are established and effective treatment options for various side effects of cancer treatments such as surgery, chemotherapy and radiotherapy. The advent of eHealth brings new opportunities to influence healthy behaviours, using interactive and novel approaches. Influencing PA behaviours in people with cancer presents a potential application of this. The aim of this study is to evaluate the feasibility and preliminary efficacy of an intervention, using eHealth, for increasing PA in cancer survivors.Methods and analysisThis will be a single-arm pre-post feasibility study. We aim to recruit a heterogeneous sample of 60 participants from cancer clinics in St. James's Hospital, Dublin, Ireland. Eligibility criteria will include patients who have completed chemotherapy and/or radiotherapy with curative intent between 3 and 36 months prior to enrolment. The intervention will include the delivery of a 12-week PA programme. The eHealth aspect of the intervention will involve the provision of a Fitbit activity tracker, which will be used in conjunction with specific PA goals remotely prescribed and monitored by a physiotherapist. Primary outcomes will be feasibility measures related to the study (recruitment capability, data collection procedures, adherence and compliance, evaluation of the resources to implement the study and evaluation of participant responses to the intervention). Secondary measures will evaluate preliminary efficacy of the intervention in terms of clinical outcomes (body composition, PA (objective and self-report), quality of life and aerobic capacity). Primary and secondary outcomes will be assessed at baseline (as appropriate), at conclusion of the intervention and at a 6-month follow-up.Ethics and disseminationEthical approval has been granted by the St. James's Hospital/AMNCH Joint Ethics Committee (2016/05/02). Results from this study will be submitted for publication in peer-reviewed journals, as well as for presentation and dissemination at conferences in the field of oncology and survivorship.Trial registrationNCT03036436; Pre-results.

Dataset Information

Association Between Physical Activity Levels in the Hospital Setting and Hospital-Acquired Functional Decline in Elderly Patients.

Publications

Association Between Physical Activity Levels in the Hospital Setting and Hospital-Acquired Functional Decline in Elderly Patients.

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