Barriers to mobility during hospitalization from the perspectives of older patients and their nurses and physicians

Abstract

Recognizing and understanding perceived barriers to mobility during hospitalization of older patients is an important first step toward developing successful interventions to minimize low mobility.

Factors that differentiate level of ambulation in hospitalised older adults

“…For example, we did not assess patient perceptions and attitudes. A recent study has found that 97% of geriatric patients report symptoms related to their condition influence how much they walked in hospital [4]. Second, CART analysis is a data-driven statistical technique [17].…”

“…Identifying factors associated with varied levels of ambulation would help clinicians identify older patients at risk for low levels of mobility. Although, previous studies have investigated perceived barriers to ambulation during hospitalisation from the perspectives of older patients and their primary nurses and physicians [4], no study has examined relevant factors using direct measures of ambulatory activity such as step counts.…”

“…Time spent sitting or lying affects muscle physiology [4], is thought to accelerate sarcopenia [5], and to be a determinant driver of the obesity epidemic [6]. These two effects of SB: obesity and low muscle strength appear to potentiate each other to increase risk of disablement and frailty in older adults [7].…”

The Greenville Early Mobility Scale

“…[2][3][4][5][6][7][8] Deleterious effects of limited or no mobility further include deconditioning, neuromuscular weakness, pulmonary dysfunction, joint contractures, pressure ulcers, and deep vein thromboses. Although the benefits and safety of early mobility activities, particularly in intensive care units, have been reported, [9][10][11][12][13] early mobilization of hospitalized patients remains a challenge. An evaluation of physical activities in hospitalized patients revealed that 24% of individuals did not have any documented ambulation during the first 7 days of hospitalization.…”

“…8,10,13 Although improving these factors may alleviate some of the "wait time" for physical therapists (PTs) to direct patient mobility, it does not address appropriate use of resources. Specifically, many patients may require the skills of PTs for safe transfer and ambulation, whereas others do not.…”