Abstract
The effects of in-hospital physical activity (PA) on outcomes among elderly patients has seldom been assessed. To assess PA levels among elderly patients hospitalized for acute medical illness and to examine the association between PA levels and functional decline and other clinical outcomes at discharge. This monocentric cohort study was performed among patients 65 years or older who were admitted for acute medical illness to the internal medicine ward of Lausanne University Hospital, Lausanne, Switzerland, from February 1 through November 30, 2018. Data were analyzed from January 1 through December 2, 2019. Daytime and 24-hour PA levels assessed via wrist accelerometers and measured in millig units (mG; 1 mG = 9.80665 × 10-3 m/s2). Functional decline (defined as a ≥5-point decrease in the modified Barthel Index), risk of bedsores, length of stay (LOS), and inability to return home. A total of 177 patients (106 [59.9%] men; median age, 83 [interquartile range, 74-87] years) were included. Lower mean (SD) PA levels were found in patients using walking aids before admission (daytime, 12 [5] vs 15 [7] mG; 24-hour, 10 [3] vs 11 [5] mG), those admitted for a reason associated with functional decline (daytime, 12 [6] vs 14 [7] mG; 24-hour, 10 [4] vs 11 [4] mG), or those prescribed physiotherapy (daytime, 12 [5] vs 15 [7] mG; 24-hour, 10 [4] vs 12 [5] mG). At discharge, functional decline was found in 63 patients (35.6%; 95% CI, 25.6%-43.1%), bedsore risk in 78 (44.1%; 95% CI, 36.6%-51.7%), and inability to return home in 82 (46.3%; 95% CI, 38.8%-54.0%). After multivariate analysis, no association was found between PA levels and functional decline (multivariable-adjusted mean [SE], 13 [1] vs 13 [1] mG for daytime levels [P = .69] and 10 [1] vs 11 [1] mG for 24-hour PA levels [P = .45]) or LOS (Spearman rank correlation, ρ = -0.06 for daytime PA levels [P = .93] and -0.01 for 24-hour PA levels [P = .52]). Patients at risk of bedsores had significantly lower PA levels than those not at risk (multivariable-adjusted mean [SE], 12 [1] vs 15 [1] mG for daytime PA levels [P = .008]; 10 [1] vs 12 [1] mG for 24-hour PA levels [P = .01]). Patients able to return home had significantly higher PA levels than those institutionalized (multivariable-adjusted mean [SE], 14 [1] vs 12 [1] mG for daytime PA levels [P = .04]; 11 [1] vs 10 [1] mG for 24-hour PA levels [P = .009]). In this study, lower in-hospital daytime and 24-hour PA levels were associated with risk of bedsores and inability to return home on discharge. These findings are important given that one-third of elderly patients present with hospital-acquired functional decline.
Highlights
The presence of low physical activity (PA) levels among elderly hospitalized patients is an underrecognized epidemic.1 during hospitalization for acute illness, 16% to 33% of elderly patients perform very little or no PA.2,3 most elderly patients who are able to walk independently before admission spend most of their time (83%) lying in bed.1 Low PA levels decrease muscle strength and mass,4 and several studies have shown that inactivity during hospitalization is associated with a wide range of negative outcomes, such as hospital-acquired functional decline, increased risk of falls, longer length of hospitalization, and new institutionalization.2,4-6Measurement of PA in the hospital setting relies mostly on qualitative nurse3 or physician7 perception and is poorly documented in hospital electronic records,8 limiting its clinical usefulness
Lower mean (SD) PA levels were found in patients using walking aids before admission, those admitted for a reason associated with functional decline, or those prescribed physiotherapy
Functional decline was found in 63 patients (35.6%; 95% CI, 25.6%-43.1%), bedsore risk in 78 (44.1%; 95% CI, 36.6%-51.7%), and inability to return home in 82 (46.3%; 95% CI, 38.8%-54.0%)
Summary
The presence of low physical activity (PA) levels among elderly hospitalized patients is an underrecognized epidemic. during hospitalization for acute illness, 16% to 33% of elderly patients perform very little or no PA. most elderly patients who are able to walk independently before admission spend most of their time (83%) lying in bed. Low PA levels decrease muscle strength and mass, and several studies have shown that inactivity during hospitalization is associated with a wide range of negative outcomes, such as hospital-acquired functional decline, increased risk of falls, longer length of hospitalization, and new institutionalization.2,4-6Measurement of PA in the hospital setting relies mostly on qualitative nurse or physician perception and is poorly documented in hospital electronic records, limiting its clinical usefulness. The presence of low physical activity (PA) levels among elderly hospitalized patients is an underrecognized epidemic.. During hospitalization for acute illness, 16% to 33% of elderly patients perform very little or no PA.. Most elderly patients who are able to walk independently before admission spend most of their time (83%) lying in bed.. Low PA levels decrease muscle strength and mass, and several studies have shown that inactivity during hospitalization is associated with a wide range of negative outcomes, such as hospital-acquired functional decline, increased risk of falls, longer length of hospitalization, and new institutionalization.. The use of accelerometers allowed the collection of accurate, objective, and continuous PA data in hospitalized patients.. Irrespective of the PA data collected (mean acceleration, steps count, gait velocity, and time of inactivity), all studies performed in the hospital setting confirmed that PA intensity and amount is low among elderly inpatients. The use of accelerometers allowed the collection of accurate, objective, and continuous PA data in hospitalized patients. Irrespective of the PA data collected (mean acceleration, steps count, gait velocity, and time of inactivity), all studies performed in the hospital setting confirmed that PA intensity and amount is low among elderly inpatients.
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