Abstract
ObjectivesTo determine the number of steps taken by older patients in hospital and 1 week after discharge; to identify factors associated with step numbers after discharge; and to examine the association between functional decline and step numbers after discharge. DesignProspective observational cohort study conducted in 2015–2017. Setting and ParticipantsOlder adults (≥70 years of age) acutely hospitalized for at least 48 hours at internal, cardiology, or geriatric wards in 6 Dutch hospitals. MethodsSteps were counted using the Fitbit Flex accelerometer during hospitalization and 1 week after discharge. Demographic, somatic, physical, and psychosocial factors were assessed during hospitalization. Functional decline was determined 1 month after discharge using the Katz activities of daily living index. ResultsThe analytic sample included 188 participants [mean age (standard deviation) 79.1 (6.7)]. One month postdischarge, 33 out of 174 participants (19%) experienced functional decline. The median number of steps was 656 [interquartile range (IQR), 250–1146] at the last day of hospitalization. This increased to 1750 (IQR 675–4114) steps 1 day postdischarge, and to 1997 (IQR 938–4098) steps 7 days postdischarge. Age [β = −57.93; 95% confidence interval (CI) −111.15 to −4.71], physical performance (β = 224.95; 95% CI 117.79–332.11), and steps in hospital (β = 0.76; 95% CI 0.46–1.06) were associated with steps postdischarge. There was a significant association between step numbers after discharge and functional decline 1 month after discharge (β = −1400; 95% CI –2380 to −420; P = .005). Conclusions and ImplicationsAmong acutely hospitalized older adults, step numbers double 1 day postdischarge, indicating that their capacity is underutilized during hospitalization. Physical performance and physical activity during hospitalization are key to increasing the number of steps postdischarge. The number of steps 1 week after discharge is a promising indicator of functional decline 1 month after discharge.
Highlights
Among acutely hospitalized older adults, step numbers double 1 day postdischarge, indicating that their capacity is underutilized during hospitalization
Participants included in the analysis n = 213 No activity data n = 55 No informed consent Fitbit n = 12 Medical reason n = 46 Technical/logistic reason n = 11 Died n = 17 Lost to follow-up n = 72 Unknown multivariable linear regression analysis, we found that age (b 1⁄4 À57.93; 95% confidence interval (CI) e111.15 to À4.71), physical performance (b 1⁄4 224.95; 95% CI 117.79e332.11), and steps taken in hospital (b 1⁄4 0.76; 95% CI 0.46e1.06) were independent predictors of physical activity after discharge
Following adjustment for age, physical performance, and steps taken in hospital, there was no significant association between functional decline and step numbers after discharge (b 1⁄4 À671; 95% CI e1667 to 325; P 1⁄4 .19)
Summary
To determine the number of steps taken by older patients in hospital and 1 week after discharge; to identify factors associated with step numbers after discharge; and to examine the association between functional decline and step numbers after discharge. Functional decline was determined 1 month after discharge using the Katz activities of daily living index. 33 out of 174 participants (19%) experienced functional decline. The median number of steps was 656 [interquartile range (IQR), 250e1146] at the last day of hospitalization. Age [b 1⁄4 À57.93; 95% confidence interval (CI) À111.15 to À4.71], physical performance (b 1⁄4 224.95; 95% CI 117.79e332.11), and steps in hospital (b 1⁄4 0.76; 95% CI 0.46e1.06) were associated with steps postdischarge. There was a significant association between step numbers after discharge and functional decline 1 month after discharge (b 1⁄4 À1400; 95% CI e2380 to À420; P 1⁄4 .005)
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