Optimizing physical activity among older adults post trauma: Overcoming system and patient challenges

Abstract

By 2050 it is anticipated that close to half (40%) of all trauma patients will be over the age of 65. Recovery post trauma for these individuals is more complicated than among younger individuals. Specifically there is an increased risk for: (1) functional decline; (2) higher mortality rates; (3) longer length of stay; (4) greater resource consumption; (5) nursing home placement; (6) adverse events such as infections, pressure ulcers and falls; and (7) rehospitalization post discharge. Early mobilization has been shown to improve outcomes. Unfortunately, there are many challenges to early mobilization. The Function Focused Care Intervention was developed to overcome these challenges. The purpose of this paper was to describe the initial recruitment of the first 25 participants and delineate the challenges and successes associated with implementation of this intervention. Overall the intervention was implemented as intended and recruitment rates were consistent with other studies. Most patients were female, white and on average 79 years of age. Optimizing physical activity of patients was a low priority for the nurses with patient safety taking precedence. Patients spent most of the time in bed. Age, depression and tethering were the only factors that were associated with physical activity and functional outcomes of patients. Ongoing work is needed to keep patients physically active in the immediate post trauma recovery period.

Feasibility and Efficacy of Function-Focused Care for Orthopedic Trauma Patients

“…Despite known benefits, physical activity is not routinely encouraged and older hospitalized adults continue to engage in very low levels of activity once hospitalized (Brown, Redden, Flood, & Allman, 2009; Resnick, Galik, Wells, Boltz, & Holtzman, in press). Generally older hospitalized medical patients spend at least 83% of their acute care stay in bed (Brown et al, 2009) and engage in only 2.4 minutes (SD=2.5) of moderate level of activity ( Resnick et al, in press).…”

“…Generally older hospitalized medical patients spend at least 83% of their acute care stay in bed (Brown et al, 2009) and engage in only 2.4 minutes (SD=2.5) of moderate level of activity ( Resnick et al, in press). …”

“…Nurses working in acute care tend to focus on completing physical assessments of patients, medication administration and indirect care activities (Resnick et al, in press) with little time spent encouraging physical activity (Boltz, Resnick, Capezuti, & Shabbat, 2011; Resnick et al, in press). In addition, nurses tend to perform functional tasks for patients (e.g., bathing the patient) which further eliminates opportunities for physical activity ( Leditschke et al, 2012).…”

Cuidados a pacientes em uso de oxigenação por membrana extracorpórea

“…Studies have shown that lack of mobilization is directly linked to increased length of stay. [11][12][13][14] Implementation of this intervention has been found to physiologically improve ventilation, central and peripheral perfusion, muscle metabolism, wakefulness, and prevention of deep and venous thrombosis. 15…”

Mobility, Remobilisation, Exercise and Prevention of the Complications of Stasis

“…Through therapeutic communication with patients, nurses can ensure they are treated as individuals and that they are supported after their great trauma towards a future of independent life and to believe in the possibility that this is achievable. In acute trauma wards, there is often limited opportunity for physical activity [24], but nurses can encourage patients to remain physically active and participate in self-care so that functional decline is reduced [25].…”