Moving towards better care for hospitalized older adults: Importance of muscles and physical activity promotion

Older adults account for a large proportion of all hospital admissions and this will further rise. A hospital admission is a critical event for older adults. Hospitalized older adults are vulnerable making them prone for negative health outcomes after hospitalization, like loss of functional abilities. In response, comprehensive “senior-friendly hospital” (SFH)-programs aiming to improve hospital care were developed, however, it is unclear how effective these programs are. Sarcopenia or poor muscle status, in this thesis defined as low muscle strength and muscle mass, is highly prevalent in hospitalized older adults and associated with negative health outcomes, like readmissions. It is unknown if muscle strength and mass further deteriorate during and after hospitalization. Physical inactivity is an important determinant of sarcopenia. Routines of activities of daily living (ADL) and physical activity levels are disrupted during hospitalization resulting in hospitalized older adults being physically inactive, spending approximately 80% of the day in bed. Physical activity in hospitalized older adults is not routinely promoted by health care professionals and is challenging since it requires knowledge, and attitude and behavioral changes in patients and health care professionals. The aim of this thesis was to evaluate how care for hospitalized older adults can be improved focusing on 1) SFH-programs, their elements and effectiveness in improving care, 2) associations between poor muscle status and higher risks for negative health outcomes, and 3) aspects of physical activity promotion in older adults during hospitalization. In chapter 2, an overview was provided of ten SFH-programs introduced in various countries between 1990-2017. Elements of SFH-programs may improve care for hospitalized older adults, however, little was published on the effect of such programs on quality of care and patient satisfaction. In chapter 3, 4, and 5, the associations of poor muscle status and higher risks for negative health outcomes in hospitalized older adults were examined addressing the high prevalence of sarcopenia at admission and its association with long-term mortality, the association of lower muscle strength and muscle mass and being at risk of a higher cumulative number of geriatric conditions, and the results of a systematic review and meta-analysis of the change in muscle strength and muscle mass in older adults during hospitalization. In chapter 6, 7, and 8, aspects of how physical activity promotion can be effectuated in clinical practice were described. Evidence for the effect of physical interventions during hospitalization, for instance exercise programs, on lower risks for negative health outcome was found to be inconclusive. Considering the detrimental effects of physical inactivity in older adults during hospitalization, it remains important to pay attention to increasing general levels of physical activity during hospital stay. Important aspects to promote physical activity during hospitalization identified in this thesis are that 1) it takes a multidisciplinary approach, including nurses, physicians, physiotherapist, patients, and carers, with clear description of roles and responsibilities, and 2) barriers and enablers influencing physical activity promotion should be acknowledged to facilitate hospital staff and patients. Improving care for hospitalized older adults requires an integrated approach. Next to a general approach to increase awareness and physical activity promotion within the hospital, it is of importance to focus on a more tailored approach in implementing “senior-friendly” care which requires effort in identifying the right patients for the right interventions at the right time

Physical, motivational and environmental factors influencing physical activity promotion during hospitalization: Older patients’ perspective

10.1016/j.gerinurse.2021.02.013Geriatric Nursing422599-60

Effect of physical interventions on physical performance and physical activity in older patients during hospitalization: a systematic review

10.1186/s12877-018-0965-2BMC GERIATRICS18

Tasks and responsibilities in physical activity promotion of older patients during hospitalization:A nurse perspective

Aim: To investigate how nurses perceive tasks and responsibilities in physical activity promotion of hospitalized older patients and which factors are of influence. Design: Mixed methods sequential explanatory design. Methods: One hundred and eight nurses participated in a questionnaire survey and 51 nurses in a subsequent in-depth interview. Data were collected on tasks and responsibilities in physical activity promotion and their influencing factors as perceived by nurses. Quantitative data were analysed using descriptive statistics and a deductive approach with directed content analysis was used for the data from the interviews. Results: Nurses perceived to have a dominant role in physical activity promotion of older patients during hospitalization. Ninety per cent of the nurses stated to be responsible for physical activity promotion and 32% stated to be satisfied with the actual level of physical activity of their patients. Nurses have specified to be responsible for signalling and performing physical activity promotion tasks and had final responsibility for transfers from bed to chair and promotion of daily activities. Influencing factors were low patient motivation, high workload causing priority shifts of tasks and the role of physicians

Effect of physical interventions on physical performance and physical activity in older patients during hospitalization: A systematic review 11 Medical and Health Sciences 1117 Public Health and Health Services

Background: To counteract decline in physical performance and physical activity in older patients during hospitalization, multiple physical interventions were developed. However, it is unknown whether these are effective in this particular population. This systematic review aimed to identify the effect of physical interventions on physical performance and physical activity in older patients during hospitalization. Methods: The systematic search included PubMed, EMBASE, Cinahl, the Trials database of The Cochrane Library and SPORTdiscus from inception to 22 November 2017. Studies were included if the mean age of the patient cohort was 65 years and older and the effect of physical interventions on physical performance or physical activity was evaluated during hospitalization. Results: Fifteen randomized controlled trials met the inclusion criteria. Overall, the effect of physical interventions on physical performance was inconsistent. Patient tailored interventions, i.e. continuously adapted to the capabilities of the patient were not found to be superior over interventions that were not. Physical activity as outcome measure was not addressed. Reporting of intensity of the interventions and adherence were frequently lacking. Conclusions: Evidence for the effect of physical interventions on physical performance in older patients during hospitalization was found uncertain. Further research on the efficacy of the intervention is needed, comparing types of intervention with detailed reporting of frequency, intensity and duration

Tasks and responsibilities in physical activity promotion of older patients during hospitalization: A nurse perspective

10.1002/nop2.588NURSING OPEN761966-197

Lower cognitive function in older patients with lower muscle strength and muscle mass

Background: Low muscle strength and muscle mass are associated with adverse outcomes in older hospitalized patients. The aim of this study was to assess the association between cognitive functioning and muscle strength and muscle mass in hospitalized older patients. Methods: This prospective inception cohort included 378 patients aged 70 years or older. At admission patients were assessed for cognitive functioning by use of the Six-Item Cognitive Impairment Test (6-CIT). Muscle strength and muscle mass were assessed using handheld dynamometry and segmental multifrequency bioelectrical impedance analysis, within 48 h after admission and on day 7, or earlier on the day of discharge. Results: The data of 371 patients (mean age ± standard deviation 80.1 ± 6.4 years, 49.3% female) were available for analyses. The median (interquartile range) 6-CIT score was 4 (0-8) points. At admission, lower cognitive functioning was associated with lower muscle strength, lower skeletal muscle mass (SMM), lower appendicular lean mass, and lower SMM index. Cognitive functioning was not associated with change in muscle strength and muscle mass during hospitalization. Conclusion: This study further strengthens evidence for an association between lower cognitive functioning and lower muscle strength and muscle mass, but without a further decline during hospitalization

Muscle mass and muscle strength are associated with pre- and post-hospitalization falls in older male inpatients: a longitudinal cohort study

10.1186/s12877-018-0812-5BMC GERIATRICS18

Muscle mass and muscle strength are associated with pre- and post-hospitalization falls in older male inpatients: a longitudinal cohort study

BACKGROUND: Low muscle mass and strength are highly prevalent in inpatients. It is acknowledged that low muscle mass and strength are associated with falls in community-dwelling older adults, but it is unknown if these muscle measures are also associated with falls in a population of older inpatients. This study aimed to investigate the association between muscle measures and pre- and post-hospitalization falls in older inpatients. METHODS: An inception cohort of patients aged 70 years and older, admitted to an academic teaching hospital, was included in this study. Muscle mass and hand grip strength were measured at admission using bioelectrical impedance analysis and handheld dynamometry. Pre-hospitalization falls were dichotomized as having had at least one fall in the six months prior to admission. Post-hospitalization falls were dichotomized as having had at least one fall during the three months after discharge. Associations were analysed with logistic regression analysis. RESULTS: The study cohort comprised 378 inpatients (mean age, SD: 79.7, 6.4 years). Fifty per cent of female and 41% of male patients reported at least one fall prior to hospitalization. Post-hospitalization, 18% of female and 23% of male patients reported at least one fall. Lower muscle mass was associated with post-hospitalization falls, and lower hand grip strength was associated with both pre- and post-hospitalization falls in male, but not in female, patients. CONCLUSIONS: These findings confirm the likely involvement of muscle mass and strength in the occurrence of pre- and post-hospitalization falls in a population of older inpatients, but only in males