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

BackgroundOlder inpatients are at risk of hospital-associated geriatric syndromes including delirium, functional decline, incontinence, falls and pressure injuries. These contribute to longer hospital stays, loss of independence, and death. Effective interventions to reduce geriatric syndromes remain poorly implemented due to their complexity, and require an organised approach to change care practices and systems. Eat Walk Engage is a complex multi-component intervention with structured implementation, which has shown reduced geriatric syndromes and length of stay in pilot studies at one hospital. This study will test effectiveness of implementing Eat Walk Engage using a multi-site cluster randomised trial to inform transferability of this intervention.MethodsA hybrid study design will evaluate the effectiveness and implementation strategy of Eat Walk Engage in a real-world setting. A multisite cluster randomised study will be conducted in 8 medical and surgical wards in 4 hospitals, with one ward in each site randomised to implement Eat Walk Engage (intervention) and one to continue usual care (control). Intervention wards will be supported to develop and implement locally tailored strategies to enhance early mobility, nutrition, and meaningful activities. Resources will include a trained, mentored facilitator, audit support, a trained healthcare assistant, and support by an expert facilitator team using the i-PARIHS implementation framework. Patient outcomes and process measures before and after intervention will be compared between intervention and control wards. Primary outcomes are any hospital-associated geriatric syndrome (delirium, functional decline, falls, pressure injuries, new incontinence) and length of stay. Secondary outcomes include discharge destination; 30-day mortality, function and quality of life; 6 month readmissions; and cost-effectiveness. Process measures including patient interviews, activity mapping and mealtime audits will inform interventions in each site and measure improvement progress. Factors influencing the trajectory of implementation success will be monitored on implementation wards.DiscussionUsing a hybrid design and guided by an explicit implementation framework, the CHERISH study will establish the effectiveness, cost-effectiveness and transferability of a successful pilot program for improving care of older inpatients, and identify features that support successful implementation.Trial registration ACTRN12615000879561 registered prospectively 21/8/2015.

OBJECTIVES To propose a new multicomponent measure of hospital‐associated complications of older people (HAC‐OP) and evaluate its validity in a large hospital sample. DESIGN Observational study using baseline (pre‐intervention) data from the Collaboration for Hospitalised Elders Reducing the Impact of Stays in Hospital cluster randomized controlled trial. SETTING Acute medical and surgical wards in 4 hospitals in Queensland, Australia. PARTICIPANTS Individuals aged 65 and older (mean age 76, 48% female) with a hospital stay of 72 hours or longer (N=434). MEASUREMENTS We developed a multicomponent measure including 5 well‐recognized hospital‐associated complications of older people: hospital‐associated delirium, functional decline, incontinence, falls, and pressure injuries. To evaluate construct validity, we examined associations with common risk factors (aged ≥75, functional impairment, cognitive impairment, history of falls). To evaluate predictive validity, we examined the association between length of stay, facility discharge, and 6‐month mortality and any HAC‐OP and total number of HAC‐OP. RESULTS Overall, 192 (44%) participants had 1 or more HAC‐OP during their admission. Any HAC‐OP was strongly associated with the proposed shared risk factors, and there was a strong and graded association between HAC‐OP and length of stay (9.1±7.4 days for any HAC‐OP vs 6.8 ±4.1 days with none, p < .001), facility discharge (59/192 (31%) vs 27/242 (11%), p < .001) and 6‐month mortality (26/192 (14%) vs 17/242 (7%), p = .02). CONCLUSION This study provides evidence of construct and predictive validity of the proposed measure of HAC‐OP as a potential outcome measure for research investigating and improving hospital care of older people. J Am Geriatr Soc 67:352–356, 2019.