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Mobility Program Helps Undo ‘Toxic’ Effects of Hospitalization for Elderly

BIRMINGHAM, AL — After hospitalization, about 40% of older adults experience a decline in the ability to perform activities of daily living (ADL), with a third failing to recover within a year after discharge. Furthermore, decreased mobility during hospitalization for older adults is associated with increased risk of death, nursing home admission, and functional decline.

That’s why a mobility program tested at the University of Alabama at Birmingham is so important. A study published online by JAMA Internal Medicine found that participants were able to maintain their prehospitalization community mobility status in the month following discharge from the hospital.

Yet, a control group receiving usual care suffered a clinically significant decline in their community mobility, according to the UAB researchers.

"It is important for patients to move around and try to do what they normally do by themselves while they are in the hospital," said lead author Cynthia Brown, MD, MSPH, director of the UAB Division of Gerontology, Geriatrics, and Palliative Care. "Our goal is to make sure that they leave the hospital with the same mobility as when they came in to maintain their quality of life."

The mobility program recommended by Brown offers assistance with walking or moving from place to place at least twice a day while also including a behavioral intervention focused on goal setting and addressing mobility barriers.

For the study conducted from Jan. 12, 2010, through June 29, 2011, researchers examined the effect of an in-hospital mobility program on post-hospitalization function and community mobility in 100 patients 65 years of age or older who were hospitalized at the Birmingham Veterans Affairs Medical Center. All patients were without cognitive difficulties and able to walk two weeks prior to hospitalization, which lasted an average of three days.

Results indicate that, at one month after hospitalization, the University of Alabama at Birmingham Study of Aging Life-Space Assessment (LSA) score was significantly higher in the mobility program (MP) group, 52.5, compared with the usual care (UC) group, 41.6. While the LSA score one month post-hospitalization was similar to the score at admission for the MP program group, it dropped about 10 points for the usual care group, study authors pointed out.

“A simple MP intervention had no effect on ADL function,” study authors concluded. “However, the MP intervention enabled patients to maintain their prehospitalization community mobility, whereas those in the UC group experienced clinically significant declines. Lower life-space mobility is associated with increased risk of death, nursing home admission, and functional decline, suggesting that declines such as those observed in the UC group would be of great clinical importance.”

S. Ryan Greysen, MD, MHS, of the University of California, San Francisco, argues in a linked commentary that more research should be conducted on mobility issues after hospitalization.

“Bedrest is toxic to older adults. Initially a clinical observation,” Greysen wrote. “This statement has become axiomatic in geriatric medicine and now rests on nearly three decades of rigorous scientific investigation demonstrating underlying pathophysiologic mechanisms of immobility and clinical outcomes research demonstrating associations with disability, nursing home placement, and mortality. Indeed, half of permanent disability in older adults begins with hospitalization, and two of three older adults who experience hospital-acquired disability will be placed in a nursing home or dead within a year of discharge.”

He asked, “If low hospital mobility is an epidemic, why haven’t more interventional studies been performed? Why hasn’t practice changed in recent decades in light of the existing evidence about the toxic effects of bedrest?”