Seniors mobility after hospitalization in question

Motivation and expectation are cited as positive influences to encourage older patients to regain their lost functional ability after hospitalization, says researchers with the Birmingham Veterans Administration Medical Center and UAB (University of Alabama at Birmingham).

The criteria used to determine the functional level of seniors before and after hospitalization is UAB's Study of Aging Life-Space Assessment, a measure of mobility developed at UAB's Center for Aging by Richard Allman, M.D., and Patricia Baker, Ph.D.

The reason why the patient is hospitalized plays a huge contributing factor: on average, patients hospitalized for surgery had a sharp decline in life-space scores immediately after surgery; however, returned to pre-surgical scores within one year. While patients who checked in for illness or other medical reasons had lower post-hospitalization scores, but did not return to their pre-hospitalization levels even after two years.

"Patients who undergo surgery expect their medical condition to be fixed and thus to be able to function as well as or better than before. Our analysis indicates that, by and large, that occurs," says Cynthia Brown, M.D., assistant professor in UAB's Division of Gerontology, Geriatrics and Palliative Care and an investigator with the VA's Geriatric Research, Education and Clinical Center.

Whereas the non-surgical older patients who are in the hospital for medical issues such as pneumonia or heart disease, typically do not return to baseline and their level of mobility goes on a permanent downward spiral.

Attitude is seen as an influencer - there is no real expectation of full recovery of function by any of the team members: patient, family or the health care providers. These patients are bed-ridden and immobile during their stay due to multiple ailments that complicate and prolong treatment. Add to this, increased medication leading to confusion and depression.

Efforts to boost physical and cognitive activity need to be examined. "Mental status and physical function are targets for intervention during hospitalization," says Brown. "We need to look at our hospital culture to understand why surgical patients return to function and those hospitalized for illness do not and to develop interventions to prevent that decline."

Brown said, "We need to see about getting these patients up and out of their hospital beds. If we can get these people up faster, perhaps we can reduce hospitalization stays and reduce the risk of falls."

There is hope on the horizon with Acute Care of Elders (ACE) units showing some promise in reducing the decline through the use of patient-centered care, discharge planning, medication review all within a specialized environment.

The Life-Space Assessment not only measures an individual's mobility but also their degree of independence. Life-Space is based on the distance a person regularly travels to perform tasks. Specific components include: how often a person leaves his/her residence, the distance from the residence they travel and how much they need assistance from others or from assistive devices.

Once the patient is home after hospitalization, community mobility and participation in everyday life are important indicators of their functional ability. Any difference in life-space measurements may reveal a change in distance and frequency of travel from home. "Mobility is a core function that reflects the lifestyle of community-dwelling adults and is an important indicator of morbidity and mortality," said Brown.

As long as the individual can do simple tasks like go to church, go out to dinner and go to the doctor's office... they still have their get up and go. Most importantly they are still participating in society.

Source: “Study Looks At Functional Decline In Older Patients After Hospitalization” Medical News Today. 8 April 2009