Perspectives of patients and clinicians on older patient mobility on acute medical wards: a qualitative study

Abstract

Background Low mobility during an acute care medical hospitalization is frequent and associated with adverse outcomes, particularly among older patients. Better understanding barriers and facilitators to improve mobility during hospitalization could help develop effective interventions. The goal of this study was to assess barriers and facilitators to older medical patients’ hospital mobility, from the point of view of patients and clinicians, to develop a framework applicable in clinical practice. Methods We conducted a qualitative study in one university and two non-university hospitals of two different language and cultural regions of Switzerland, including 13 focus groups (FGs; five with patients, eight with clinicians). We included 24 adults aged 60 years or older hospitalized on an acute general internal medicine ward of one of the three participating hospitals during the previous years, and 34 clinicians (15 physicians, nine nurses/nursing assistants, 10 physiotherapists) working on those wards. The FG guides included open-ended questions exploring mobility experiences, expectations, barriers and facilitators to mobility, consequences of low mobility and knowledge on mobility. We applied an inductive thematic analysis. Results We identified four themes of barriers and facilitators to mobility: 1) patient-related factors; 2) clinician-related factors; 3) social interactions; and 4) non-human factors. Clinician-related factors were only mentioned in clinician FGs. Otherwise, subthemes identified from patient and clinician FGs were similar and codes broadly overlapped. Subthemes included motivation, knowledge, expectations, mental and physical state (theme 1); process, knowledge – skills, mental state – motivation (theme 2); interpersonal relationships, support (theme 3); hospital setting – organization (theme 4). Conclusions From patients’ and clinicians’ perspectives, a broad spectrum of human and structural factors influences mobility of older patients hospitalized on an acute general internal medicine ward. New factors included privacy issues and role perception. Many of those factors are potentially actionable without additional staff resources. This study is a first step in participatory research to improve mobility of older medical inpatients.

Factors impeding physical activity in older hospitalised patients: A qualitative meta‐synthesis

“…On the one hand, medical staff's heavy workload, limited human resources, lack of PA education, and hospital culture have neglected patients' activity needs. We can learn from foreign countries to train professional volunteers (Lim et al, 2020) to provide PA services for patients to provide quality services; give personalised and safe PA advice according to patients' condition status and needs, and quantify the goals (Herzog et al, 2023). On et al (2023).…”

“…On the one hand, medical staff's heavy workload, limited human resources, lack of PA education, and hospital culture have neglected patients' activity needs. We can learn from foreign countries to train professional volunteers (Lim et al., 2020) to provide PA services for patients to provide quality services; give personalised and safe PA advice according to patients' condition status and needs, and quantify the goals (Herzog et al., 2023). On the other hand family members' concern about adverse outcomes of activities and taking overprotective measures, family visits and unskilled knowledge of activity skills (Koenders et al., 2021) can also make patients actively or passively give up the opportunity to be active.…”

Feasibility and Acceptability of an INtervention TO Increase MOBility in Older Hospitalized Medical Patients (INTOMOB): A Mixed-Methods Pilot Study

“…The INTOMOB intervention was developed based on barriers and facilitators identified in the literature ( Mani et al, 2022 ) and in a mixed method study (manuscript submitted and Herzog et al, 2023 ). To allow future implementation, the intervention had to require no additional resources.…”