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Key summary points: Aim: To examine different mobility outcomes of acute geriatric care in acutely hospitalized older adults and identify associated factors. Findings: Patients showed significant increases in locomotor capacity, physical activity, and life-space mobility from hospital admission to discharge, for which frailty was consistently identified as a negative independent predictor. A higher mean daily physical activity level was independently predictive of improvements in locomotor capacity. Message: Older hospitalized patients benefit from acute geriatric care in terms of distinct mobility outcomes; however, frailty-specific adaptations may be needed for frail patients to optimize their mobility outcomes. Purpose: To examine distinct mobility outcomes (locomotor capacity, physical activity, life-space mobility) of acute geriatric care (AGC) in acutely hospitalized older adults and identify predictors associated with these outcomes. Methods: The PAGER study was designed as a prospective observational study. Mobility outcomes of 107 hospitalized older patients (age = 83.2 ± 6.4 years, female: n = 68, 63.6%) receiving AGC were measured at hospital admission and discharge. Locomotor capacity was assessed with the Short Physical Performance Battery (SPPB), 24-h physical activity (step count) with an activity monitor, and life-space mobility with the Life-Space Assessment in Institutionalized Settings (LSA-IS). Baseline demographical, clinical, physical, cognitive, and psychological characteristics were analyzed as candidate predictors of mobility outcomes. Results: SPPB (median [interquartile range] 4.0 [2.8–5.0] pt. vs. 5.0 [3.0–6.3] pt.), step count (516 [89–1806] steps vs. 1111 [228–3291] steps), and LSA-IS total score (10.5 [6.0–15.0] pt. vs. 16.3 [12.0–24.1] pt.) significantly improved during AGC (all p < 0.001). Adjusting for baseline status, frailty was identified as an independent negative predictor of SPPB, step count, and LSA-IS at discharge (p = 0.003–0.005). Barthel Index was also independently positively associated with step count (p = 0.017) at discharge, as was the mean daily PA level with SPPB (p = 0.027) at discharge, both independent of baseline status. Conclusion: AGC improves distinct mobility outcomes in hospitalized older patients. Frailty was consistently found to be an independent negative predictor of all mobility outcomes. Frailty assessment in AGC may be important to identify patients at risk for decreased treatment gains in mobility. Early PA promotion in AGC seems to be beneficial in improving patients' locomotor capacity. [ABSTRACT FROM AUTHOR]

Background and Purpose: The Patient-Specific Functional Scale (PSFS) is an individualized patient-reported outcome measure designed to assess the limitations and changes in self-determined functional activities most important to an older patient in the acute care setting. However, its clinimetric properties have not yet been evaluated in these patients. The study aimed to investigate the construct validity, test-retest reliability, sensitivity to change, and feasibility of the PSFS in acutely hospitalized older patients with and without cognitive impairment (CI). Methods: The clinimetric properties of the PSFS were investigated by secondary data analysis from a prospective observational cohort study examining physical activity and mobility in acutely hospitalized older patients. In this analysis, 120 older patients—83.0 (6.4) years—with and without CI (Mini-Mental State Examination [MMSE] score 18-23, n = 52, and MMSE ≥24, n = 68, respectively) receiving early multidisciplinary geriatric rehabilitation in acute care were included. Construct validity was assessed by Spearman correlations (r s) with the Activity-specific Balance Confidence Scale (ABC-6), Short Falls Efficacy Scale-International (Short FES-I), EuroQoL-5 Dimensions (EQ-5D), Short Physical Performance Battery (SPPB), de Morton Mobility Index (DEMMI), and Barthel Index (BI); test-retest reliability within 24 hours by intraclass correlation coefficients (ICCs); sensitivity to change by standardized response means (SRMs) calculated for treatment effects, and feasibility by completion rates/times and floor/ceiling effects. Results: The PSFS showed fair to moderate correlations with all construct variables in patients with CI (r s = 0.31 to 0.53). In patients without CI, correlations were fair for the ABC-6, FES-I, EQ-5D, and BI (r s = |0.27 to 0.36|), but low for the SPPB and DEMMI (r s =−0.04 to 0.14). Test-retest reliability (both: ICC = 0.76) and sensitivity to change (CI: SRM = 1.10, non-CI: SRM = 0.89) were excellent in both subgroups. Excellent feasibility was documented by high completion rates (>94%), brief completion times (<8 min), and no floor/ceiling effects in either subgroup. Conclusions: The PSFS has adequate clinimetric properties for assessing patient-specific functional limitations and changes in acutely hospitalized older patients with and without CI. It might be an appropriate complement to traditional functional scales to enhance patient-centeredness in clinical geriatric assessment. [ABSTRACT FROM AUTHOR]