Mobility Activity and Its Value as a Prognostic Indicator of Survival in Hospitalized Older Adults

Abstract

OBJECTIVES Our goal was to objectively assess total steps and minutes active in the first and last 24-hours of hospitalization and examine associations with survival post-discharge in hospitalized older patients. DESIGN A prospective study. SETTING A 20-bed Acute Care for Elders (ACE) hospital unit. PARTICIPANTS Two hundred and twenty-four older adults admitted to an ACE hospital unit. MEASUREMENTS A StepWatch Activity Monitor collected information on total steps and minutes of activity in the first and last 24-hours of hospitalization. The main outcome was 2-year survival from hospital discharge date. RESULTS Patients were active for about 80 minutes in the first 24-hours of hospitalization. Minutes active increased about 28 minutes in the last 24-hours of hospitalization for patients aged 65–84, but were essentially unchanged for those aged 85 or older. The median step count for patients was low, with a median of 478 and 846 steps in the first and last 24-hours of hospitalization, respectively. Multivariate survival models showed that in the first and last 24-hours of hospitalization each 100 step increase was associated with a 2% (HR 0.98; 95% CI 0.96–1.00) and 3% (HR 0.97; 95% CI 0.94–0.99) decreased risk of death over 2-years, respectively. A decline in steps from first to last 24-hours of hospitalization was associated with more than a four-fold increase risk of death (HR 4.21; 95% CI 1.65–10.77) two-years post discharge. CONCLUSION Accelerometers could provide meaningful information about the walking activity of patients. Of importance is the potential to apply objective information about the patient’s functional status to improve the delivery of healthcare and health outcomes.

In-patient step count predicts re-hospitalization after cardiac surgery

“…Therefore, replication of our study in other types of hospital and other areas of the country is necessary to give meaning to the figure of 1308 steps taken predischarge. Recent studies also indicate that a low step count in hospitalized older patients is an important predictor of adverse outcome although the patient population and duration of hospitalization both differ from our study [26][27][28]. Further studies are necessary to develop an optimal level or threshold of daily steps needed to prevent re-hospitalization.…”

Physical activity among hospitalized older adults – an observational study

“…Based on results from Ostir [9], Villumsen [7] and the present study, we may speculate if the particular focus on mobilization in geriatric wards is one factor explaining why studies from geriatric wards report higher levels of physical activity than studies on patients in general medical wards [4–6]. Our group has previously compared the level of physical activity among hip fracture patients in a geriatric ward and in an orthopedic ward [10], finding a higher level of physical activity for patients in the geriatric ward.…”

Prognostic Value of Braden Activity Subscale for Mobility Status in Hospitalized Older Adults

“…In addition, the results of this single-center study cannot be generalized across all hospital systems. The Braden activity sub score has demonstrated good validity and reliability for activity changes 13 , but this measure was not objectively ascertained as demonstrated by others using accelerometers 6–7 . Moreover, the medical records used did not provide prehospital patient mobility status, limiting adjustments for prehospital mobility function.…”