Optimizing Function and Physical Activity in Hospitalized Older Adults to Prevent Functional Decline and Falls

2019 ◽  
Vol 35 (2) ◽  
pp. 237-251 ◽  
Author(s):  
Barbara Resnick ◽  
Marie Boltz
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Functional Decline ◽  
Hospitalized Older Adults

Depressive Symptoms and Malnutrition are Associated with Other Geriatric Syndromes and Increase Risk for 30-Day Readmission in Hospitalized Older Adults: A Prospective Cohort Study

2022 ◽  
Author(s):  
Laura Tay ◽  
Melvin Chua ◽  
Yew Yoong Ding
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Depressive Symptoms ◽  
Functional Decline ◽  
Oral Intake ◽  
Index Admission ◽  
Geriatric Syndromes ◽  
Poor Oral Intake ◽  
Hospitalized Older Adults ◽  
Minimal Adjustment

Abstract Background: Readmission in older adults is typically complex with multiple contributing factors. We aim to examine how two prevalent and potentially modifiable geriatric conditions – depressive symptoms and malnutrition – relate to other geriatric syndromes and 30-day readmission in hospitalized older adults. Methods: Consecutive admissions of patients >65 years to a general medical department were recruited over 15 months. Patients were screened for depression, malnutrition, delirium, cognitive impairment, and frailty at admission. Medical records were reviewed for intermediary events including poor oral intake and functional decline during hospitalization. Unplanned readmission within 30-days of discharge was tracked through the hospital’s electronic health records and follow-up telephone interviews. We use directed acyclic graphs (DAGs) to depict the relationship of depressive symptoms and malnutrition with geriatric syndromes that constitute covariates of interest and 30-day readmission outcome. Multiple logistic regression was performed for the independent associations of depressive symptoms and malnutrition with 30-day readmission, adjusting for variables based on DAG-identified minimal adjustment set. Results: We recruited 1619 consecutive admissions, with mean age 76.4 (7.9) years and 51.3% females. 30-day readmission occurred in 331 (22.0%) patients. Depressive symptoms (OR 1.55, 95% CI 1.15-2.07), malnutrition (OR 1.59, 95% CI 1.14-2.23), higher comorbidity burden, hospitalization in the one-year preceding index admission, frailty, delirium, as well as functional decline and poor oral intake during the index admission, were more commonly observed among patients who were readmitted within 30 days of discharge (P<0.05). Patients with active depressive symptoms were significantly more likely to be frail (OR=1.62, 95% CI 1.22-2.16), had poor oral intake (OR=1.35, 95% CI 1.02-1.79) and functional decline during admission (OR=1.58, 95% CI 1.11-2.23). Malnutrition at admission was significantly associated with frailty, delirium, cognitive impairment and poor oral intake during hospitalization (P<0.05). In minimal adjustment set identified by DAG, depressive symptoms (OR=1.38, 95% CI 1.02-1.86) remained significantly associated with 30-day readmission. The association of malnutrition with 30-day readmission was attenuated after adjusting for age, ethnicity and depressive symptoms in the minimal adjustment set (OR=1.40, 95% CI 0.99-1.98, P=0.06). Conclusion: The observed causal associations support screening and targeted interventions for depressive symptoms and malnutrition during admission and in the post-acute period.

Functional Decline in Hospitalized Older Adults: Can Nursing Make a Difference?

2012 ◽  
Vol 33 (4) ◽  
pp. 272-279 ◽  
Author(s):  
Marie Boltz ◽  
Barbara Resnick ◽  
Elizabeth Capezuti ◽  
Joseph Shuluk ◽  
Michelle Secic
Keyword(s):  
Older Adults ◽  
Functional Decline ◽  
Hospitalized Older Adults

scholarly journals Daytime Physical Activity and Sleep in Hospitalized Older Adults: Association with Demographic Characteristics and Disease Severity

2015 ◽  
Vol 63 (7) ◽  
pp. 1391-1400 ◽  
Author(s):  
Claire Beveridge ◽  
Kristen Knutson ◽  
Lisa Spampinato ◽  
Andrea Flores ◽  
David O. Meltzer ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Disease Severity ◽  
Demographic Characteristics ◽  
Hospitalized Older Adults

scholarly journals Effects of Mobile Health App Interventions on Sedentary Time, Physical Activity, and Fitness in Older Adults: Systematic Review and Meta-Analysis

10.2196/14343 ◽  
2019 ◽  
Vol 21 (11) ◽  
pp. e14343 ◽  
Author(s):  
Dharani Yerrakalva ◽  
Dhrupadh Yerrakalva ◽  
Samantha Hajna ◽  
Simon Griffin
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Mobile Health ◽  
Sedentary Time ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Functional Decline ◽  
Risk Of Bias ◽  
Community Dwelling ◽  
Increased Risk

Background High sedentary time, low physical activity (PA), and low physical fitness place older adults at increased risk of chronic diseases, functional decline, and premature mortality. Mobile health (mHealth) apps, apps that run on mobile platforms, may help promote active living. Objective We aimed to quantify the effect of mHealth app interventions on sedentary time, PA, and fitness in older adults. Methods We systematically searched five electronic databases for trials investigating the effects of mHealth app interventions on sedentary time, PA, and fitness among community-dwelling older adults aged 55 years and older. We calculated pooled standardized mean differences (SMDs) in these outcomes between the intervention and control groups after the intervention period. We performed a Cochrane risk of bias assessment and Grading of Recommendations, Assessment, Development, and Evaluation certainty assessment. Results Overall, six trials (486 participants, 66.7% [324/486] women; age mean 68 [SD 6] years) were included (five of these trials were included in the meta-analysis). mHealth app interventions may be associated with decreases in sedentary time (SMD=−0.49; 95% CI −1.02 to 0.03), increases in PA (506 steps/day; 95% CI −80 to 1092), and increases in fitness (SMD=0.31; 95% CI −0.09 to 0.70) in trials of 3 months or shorter and with increases in PA (753 steps/day; 95% CI −147 to 1652) in trials of 6 months or longer. Risk of bias was low for all but one study. The quality of evidence was moderate for PA and sedentary time and low for fitness. Conclusions mHealth app interventions have the potential to promote changes in sedentary time and PA over the short term, but the results did not achieve statistical significance, possibly because studies were underpowered by small participant numbers. We highlight a need for larger trials with longer follow-up to clarify if apps deliver sustained clinically important effects.

scholarly journals Effects of Mobile Health App Interventions on Sedentary Time, Physical Activity, and Fitness in Older Adults: Systematic Review and Meta-Analysis (Preprint)

2019 ◽  
Author(s):  
Dharani Yerrakalva ◽  
Dhrupadh Yerrakalva ◽  
Samantha Hajna ◽  
Simon Griffin
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Mobile Health ◽  
Sedentary Time ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Functional Decline ◽  
Risk Of Bias ◽  
Community Dwelling ◽  
Increased Risk

BACKGROUND High sedentary time, low physical activity (PA), and low physical fitness place older adults at increased risk of chronic diseases, functional decline, and premature mortality. Mobile health (mHealth) apps, apps that run on mobile platforms, may help promote active living. OBJECTIVE We aimed to quantify the effect of mHealth app interventions on sedentary time, PA, and fitness in older adults. METHODS We systematically searched five electronic databases for trials investigating the effects of mHealth app interventions on sedentary time, PA, and fitness among community-dwelling older adults aged 55 years and older. We calculated pooled standardized mean differences (SMDs) in these outcomes between the intervention and control groups after the intervention period. We performed a Cochrane risk of bias assessment and Grading of Recommendations, Assessment, Development, and Evaluation certainty assessment. RESULTS Overall, six trials (486 participants, 66.7% [324/486] women; age mean 68 [SD 6] years) were included (five of these trials were included in the meta-analysis). mHealth app interventions may be associated with decreases in sedentary time (SMD=−0.49; 95% CI −1.02 to 0.03), increases in PA (506 steps/day; 95% CI −80 to 1092), and increases in fitness (SMD=0.31; 95% CI −0.09 to 0.70) in trials of 3 months or shorter and with increases in PA (753 steps/day; 95% CI −147 to 1652) in trials of 6 months or longer. Risk of bias was low for all but one study. The quality of evidence was moderate for PA and sedentary time and low for fitness. CONCLUSIONS mHealth app interventions have the potential to promote changes in sedentary time and PA over the short term, but the results did not achieve statistical significance, possibly because studies were underpowered by small participant numbers. We highlight a need for larger trials with longer follow-up to clarify if apps deliver sustained clinically important effects.

Frailty, functional decline and mortality in hospitalized older adults

2017 ◽  
Vol 17 (4) ◽  
pp. 664-666 ◽  
Author(s):  
Juan J. Baztán ◽  
María De la Puente ◽  
Alberto Socorro
Keyword(s):  
Older Adults ◽  
Functional Decline ◽  
Hospitalized Older Adults

scholarly journals DEVELOPMENT AND TESTING OF AN ACCELEROMETER-BASED POSITIONAL MONITORING SYSTEM

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S336-S337
Author(s):  
Leighanne Jarvis ◽  
Sarah Moninger ◽  
Chandra Throckmorton ◽  
Juliessa M Pavon ◽  
Kevin Caves
Keyword(s):  
Older Adults ◽  
Functional Disability ◽  
Learning Algorithm ◽  
Functional Decline ◽  
Accelerometer Data ◽  
Contributing Factors ◽  
Postural Changes ◽  
Patient Reported ◽  
The Subject ◽  
Hospitalized Older Adults

Abstract Health and fitness are contributing factors to physical resilience, or the ability to resist or recover from functional decline following health stressors. Accelerometer based activity monitors have been used in both the in-patient and outpatient setting to monitor mobility. While using sensors to track mobility is increasing, most clinical settings rely on patient reported outcomes. These measures often under or overestimate movement. The lack of a clinically meaningful way to measure mobility in the in-patient setting is a barrier to improving the mobility of hospitalized individuals. This is especially important when considering that over one-third of hospitalized older adults are discharged with a major new functional disability in performing activities of daily living. Our goal was to automatically determine if the subject is laying, reclining, sitting, standing, and walking to better reflect actual activity. Other platforms and studies indicate the ability to determine a difference in activity vs. inactivity or laying and reclining vs. standing and walking, but not all five phases of movement defined here. The aim of this study was to use accelerometer data to train a machine learning algorithm to automatically classify the postural changes (i.e. laying, reclining, sitting, standing, and walking). Preliminary results demonstrate that our trained algorithm is overall 95% accurate in determining each position from unlabeled data from the subject population. Additionally, this algorithm will be applied to in-patient hospitalized older adults for tracking of positions throughout the day.

How “care values” as discursive practices effect the ethics of a care-setting

2019 ◽  
Vol 8 (3) ◽  
pp. 298-311
Author(s):  
Jeannine Therese Moreau ◽  
Trudy Rudge
Keyword(s):  
Older Adults ◽  
Older Adult ◽  
Social Order ◽  
Social Practice ◽  
Care Setting ◽  
Functional Decline ◽  
Discursive Practices ◽  
Content Type ◽  
Hospitalized Older Adults ◽  
Measurement Efficiency

Purpose This paper examines how certain care values permeate, legitimize and authorize hospitalized-older-adults’ care, technologies and practices. The purpose of this paper is to expose how values are not benign but operate discursively establishing “orders of worth” with significant effect on the ethics of the care-setting. Design/methodology/approach The paper draws from a discursive ethnography to see “up close” on a surgical unit how values influence nurse/older-adult-patient care occasions in the domain of older-adults and functional decline. Data are from participant observations, conversations, interviews, chart reviews and reviewed literature. Foucauldian discursive analytics rendered values recognizable and analyzable as discursive practices. Discourse is a social practice of knowledge production constituting and giving meaning to what it represents. Findings Analysis reveals how care values inhere discourses like measurement, efficiency, economics, risk and functional decline (loss of capacity for independent living) pervading care technologies and practices, subjugating older adults’ bodies to techniques, turning older persons into measurable objects of knowledge. These values determine social conditions of worth, objectifying, calculating, normalizing and homogenizing what it means to be old, ill and in hospital. Originality/value Seven older adult patients and attendant nurses were followed for their entire hospitalization. The ethnography renders visible how care values as discursive practices rationalize the social order and operations of everyday care. Analytic outcomes offer insights of how dominant care values enabled care technologies and practices to govern hospitalized-older-adults as a population to be ordered, managed and controlled, eliding possibilities of engaging humanistic patient-centered care.

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