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Factors Associated With Walking in Older Medical Inpatients

OBJECTIVE: To identify patient characteristics on admission and daily events during hospitalization that could influence older medical inpatients walking activity during hospitalization. DESIGN: A cohort study. SETTING: Acute hospitalized care. PARTICIPANTS: Premorbidly mobile, nonsurgical, nonelect...

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Autores principales: McCullagh, Ruth, Darren, Dahly, Horgan, N. Frances, Timmons, Suzanne
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7853347/
https://www.ncbi.nlm.nih.gov/pubmed/33543067
http://dx.doi.org/10.1016/j.arrct.2020.100038
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author McCullagh, Ruth
Darren, Dahly
Horgan, N. Frances
Timmons, Suzanne
author_facet McCullagh, Ruth
Darren, Dahly
Horgan, N. Frances
Timmons, Suzanne
author_sort McCullagh, Ruth
collection PubMed
description OBJECTIVE: To identify patient characteristics on admission and daily events during hospitalization that could influence older medical inpatients walking activity during hospitalization. DESIGN: A cohort study. SETTING: Acute hospitalized care. PARTICIPANTS: Premorbidly mobile, nonsurgical, nonelective inpatients (50% women) aged ≥65 years (N=154), with an anticipated ≥3-day inpatient stay were recruited consecutively within 48 hours of hospital admission. Of the 227 patients screened, 69 did not meet study criteria and 4 refused. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Age, comorbidities (Cumulative Illness Rating Scale), cognitive status (6-item Cognitive Impairment Test), falls history and efficacy (Falls Efficacy Scale-International), physical performance (short physical performance battery), and medications were recorded within 2 days of admission. Walking activity (step count) was recorded for 7 days or until discharge. Daily events (procedures, falls, fear of falling, ordered bedrest, devices or treatments that hindered walking [eg, intravenous fluids, wall-mounted oxygen therapy], patient- and nurse-reported medial status, fatigue, sleep quality, physiotherapy, or occupational therapy intervention) were measured on concurrent weekdays. Their associations with daily (log) step count were estimated using linear mixed-effects models, adjusted for patient-characteristics measured at admission. RESULTS: Approximately half of the variability in step count was described at the within-patient level. Multivariable models suggested positive associations with Wednesdays (+25% in step count; 95% confidence interval, 4-53), admission physical performance (+15%, 8-22), improving medical status (+33%, 7-64), negative associations with devices or treatments that hinder walking (−29%, −9 to −44), and instructed bedrest (−69%, −55 to −79). CONCLUSION: Day-to-day step count fluctuated, suggesting considerable scope for intervention. Devices or treatments that hinder walking should be reviewed daily and walking activity should become a clinical priority. Admission physical performance may identify vulnerable patients.
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spelling pubmed-78533472021-02-03 Factors Associated With Walking in Older Medical Inpatients McCullagh, Ruth Darren, Dahly Horgan, N. Frances Timmons, Suzanne Arch Rehabil Res Clin Transl Original Research OBJECTIVE: To identify patient characteristics on admission and daily events during hospitalization that could influence older medical inpatients walking activity during hospitalization. DESIGN: A cohort study. SETTING: Acute hospitalized care. PARTICIPANTS: Premorbidly mobile, nonsurgical, nonelective inpatients (50% women) aged ≥65 years (N=154), with an anticipated ≥3-day inpatient stay were recruited consecutively within 48 hours of hospital admission. Of the 227 patients screened, 69 did not meet study criteria and 4 refused. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Age, comorbidities (Cumulative Illness Rating Scale), cognitive status (6-item Cognitive Impairment Test), falls history and efficacy (Falls Efficacy Scale-International), physical performance (short physical performance battery), and medications were recorded within 2 days of admission. Walking activity (step count) was recorded for 7 days or until discharge. Daily events (procedures, falls, fear of falling, ordered bedrest, devices or treatments that hindered walking [eg, intravenous fluids, wall-mounted oxygen therapy], patient- and nurse-reported medial status, fatigue, sleep quality, physiotherapy, or occupational therapy intervention) were measured on concurrent weekdays. Their associations with daily (log) step count were estimated using linear mixed-effects models, adjusted for patient-characteristics measured at admission. RESULTS: Approximately half of the variability in step count was described at the within-patient level. Multivariable models suggested positive associations with Wednesdays (+25% in step count; 95% confidence interval, 4-53), admission physical performance (+15%, 8-22), improving medical status (+33%, 7-64), negative associations with devices or treatments that hinder walking (−29%, −9 to −44), and instructed bedrest (−69%, −55 to −79). CONCLUSION: Day-to-day step count fluctuated, suggesting considerable scope for intervention. Devices or treatments that hinder walking should be reviewed daily and walking activity should become a clinical priority. Admission physical performance may identify vulnerable patients. Elsevier 2020-01-11 /pmc/articles/PMC7853347/ /pubmed/33543067 http://dx.doi.org/10.1016/j.arrct.2020.100038 Text en © 2020 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Research
McCullagh, Ruth
Darren, Dahly
Horgan, N. Frances
Timmons, Suzanne
Factors Associated With Walking in Older Medical Inpatients
title Factors Associated With Walking in Older Medical Inpatients
title_full Factors Associated With Walking in Older Medical Inpatients
title_fullStr Factors Associated With Walking in Older Medical Inpatients
title_full_unstemmed Factors Associated With Walking in Older Medical Inpatients
title_short Factors Associated With Walking in Older Medical Inpatients
title_sort factors associated with walking in older medical inpatients
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7853347/
https://www.ncbi.nlm.nih.gov/pubmed/33543067
http://dx.doi.org/10.1016/j.arrct.2020.100038
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