Search

Background low mobility of hospitalised older adults is associated with adverse outcomes and imposes a significant burden on healthcare and welfare systems. Various interventions have been developed to reduce this problem; at present, however, their methodologies and outcomes vary and information is lacking about their long-term sustainability. This study aimed to evaluate the 2-year sustainability of the WALK-FOR (walking for better outcomes and recovery) intervention implemented by teams in acute care medical units. Methods a quasi-experimental three-group comparative design (N  = 366): pre-implementation, i.e. control group (n  = 150), immediate post-implementation (n  = 144) and 2-year post-implementation (n  = 72). Results mean participant age was 77.6 years (± 6 standard deviation [SD]) and 45.3% were females. We conducted an analysis of variance test to evaluate the differences in primary outcomes: number of daily steps and self-reported mobility. Levels of mobility improved significantly from the pre-implementation (control) group to the immediate and 2-year post-implementation groups. Daily step count: pre-implementation (median: 1,081, mean: 1,530 SD = 1,506), immediate post-implementation (median: 2,225, mean: 2,724. SD = 1,827) and 2-year post-implementation (median: 1,439, mean: 2,582, SD = 2,390) F  = 15.778 P  < 0.01. Self-reported mobility: pre-implementation (mean:10.9, SD = 3.5), immediate post-implementation (mean: 12.4, SD = 2.2), 2-year post-implementation (mean: 12.7, SD = 2.2), F  = 16.250, P  < 0.01. Conclusions the WALK-FOR intervention demonstrates 2-year sustainability. The theory-driven adaptation and reliance on local personnel produce an effective infrastructure for long-lasting intervention. Future studies should evaluate sustainability from a wider perspective to inform further in-hospital intervention development and implementation. [ABSTRACT FROM AUTHOR]

Background: In-hospital immobility of older adults is associated with hospital-associated functional decline (HAFD). This study examined the WALK-FOR program's effects on HAFD prevention.Methods: A quasi-experimental pre-post two-group (intervention group [IG] n = 188, control group [CG] n = 189) design was applied in two hospital internal medical units. On admission, patients reported pre-hospitalization functional status, which was assessed again at discharge and 1-month follow-up. Primary outcome was decline in basic activities of daily living (BADL), using the Modified Barthel Index. Secondary outcomes were decline in instrumental ADL (Lawton's IADL scale) and community mobility (Yale Physical Activity Survey). All participants (75.1 ± 7 years old) were cognitively intact and ambulatory at admission. The WALK-FOR included a unit-tailored mobility program utilizing patient-and-staff education with a specific mobility goal (900 steps per day), measured by accelerometer.Results: Decline in BADL occurred among 33% of the CG versus 23% of the IG (p = .02) at discharge, and among 43% of the CG versus 30% in the IG (p = .01) at 1-month follow-up. Similarly, 26% of the CG versus 15% of the IG declined in community mobility at 1-month follow-up (p = .01). Adjusted for major covariates, the intervention reduced the odds of decline in BADL by 41% (p = .05) at discharge and by 49% at 1-month follow-up (p = .01), and in community mobility by 63% (p = .02). There was no significant effect of the intervention on IADL decline (p = .19).Conclusions: The WALK-FOR intervention is effective in reducing HAFD. [ABSTRACT FROM AUTHOR]

Background: post-hospitalisation functional decline is a widely described phenomenon, yet factors related to new disability in instrumental activities of daily living (IADL) in previously independently functioning older adults are rarely studied. Objective: to test whether change in cognitive status from admission to discharge during short-term acute-care hospitalisation is associated with the incidence of medium-term post-hospitalisation IADL dependency. Design: prospective cohort study. Setting: internal medicine wards in two Israeli medical centres. Subjects: two hundred and seventy-two hospitalised older adults (≥70) who were independent in self-care and mobility activities at admission, at discharge and 1 month after discharge, and who were independent in IADL pre-admission. Methods: cognitive status was evaluated at admission and at discharge using Pfeiffer's Short Portable Mental Status Questionnaire (SPMSQ). One-month post-discharge, IADL was assessed using Lawton and Brody's scale by telephone. Results: incidence of IADL dependency was 74/272 (27.2%). Controlling for length of stay, co-morbidities, re-hospitalisation and age, a one-unit decrease in SPMSQ score during hospital stay was associated with 1.57 higher odds (95% CI, 1.14-2.15) of post-hospitalisation new IADL dependency. The odds of new IADL dependency were also significantly higher in participants who were rehospitalised within the previous month (odds ratio = 2.65; 95% CI, 1.25-5.62). Conclusions: decline in SPMSQ score during acute hospitalisation has a detrimental effect on functional decline after acute hospitalisation, defined by incidence IADL dependency. This finding emphasises the need to identify cognitive decline during hospitalisation to allow timely intervention to prevent post-discharge functional decline in this population. [ABSTRACT FROM AUTHOR]