IMPORTANCE Mobility limitations are common in older adults, affecting the physical, psychological, and social aspects of an older adult’s life. OBJECTIVE To identify mobility risk factors, screening ...tools, medical management, need for physical therapy, and efficacy of exercise interventions for older primary care patients with limited mobility. EVIDENCE ACQUISITION Search of PubMed and PEDro from January 1985 to March 31, 2013, using the search terms mobility limitation, walking difficulty, and ambulatory difficulty to identify English-language, peer-reviewed systematic reviews, meta-analyses, and Cochrane reviews assessing mobility limitation and interventions in community-dwelling older adults. Articles not appearing in the search referenced by reviewed articles were also evaluated. FINDINGS The most common risk factors for mobility impairment are older age, low physical activity, obesity, strength or balance impairment, and chronic diseases such as diabetes or arthritis. Several tools are available to assess mobility in the ambulatory setting. Referral to physical therapy is appropriate, because physical therapists can assess mobility limitations and devise curative or function-enhancing interventions. Relatively few studies support therapeutic exercise to improve mobility limitation. Strong evidence supports resistance and balance exercises for improving mobility-limiting physical weakness and balance disorders. Assessing a patient’s physical environment and the patient’s ability to adapt to it using mobility devices is critical. CONCLUSIONS AND RELEVANCE Identification of older adults at risk for mobility limitation can be accomplished through routine screening in the ambulatory setting. Addressing functional deficits and environmental barriers with exercise and mobility devices can lead to improved function, safety, and quality of life for patients with mobility limitations.
Hospital-associated disability (HAD), defined as loss of independence in activities of daily living (ADL) following acute hospitalization, is observed among older adults. The study objective is to ...determine overall prevalence of HAD among older adults hospitalized in acute care, and to assess the impact of study initiation year in moderation of prevalence.
Meta-analysis of data collected from randomized trials, quasi-experimental, and prospective cohort studies. English-language searches to identify included studies were completed February 2018 and updated May 2018 of electronic databases and reference lists of studies and reviews. Included studies were human subjects investigations that measured ADL ≥2 time points before or during and after hospitalization and reported prevalence of ADL decline among older adults.
Acute care hospital units.
Adults aged ≥65 years hospitalized in medical-surgical acute care; total sample size across all included studies was 7375.
Independence in ADL was assessed using the Katz Index of Independence in Activities of Daily Living and Barthel Index of Independence in Activities of Daily Living.
Random effects meta-analysis across included studies identified combined prevalence of HAD as 30% (95% CI 24%, 33%; P < .001). The effect of study initiation year on the prevalence rate was minimal. A large amount of heterogeneity was observed between studies, which may be due in part to nonstandardized measurement of ADL impairment or other methodological differences.
Hospitalization in acute care poses a significant risk to functional independence of older adults, and this risk is unchanged despite shorter lengths of stay. The evidence supports the continued need for hospital-based programs that provide assessment of functional ability and identification of at-risk older adults in order to better treat and prevent HAD.
OBJECTIVES: To examine the proportion of time spent in three levels of mobility (lying, sitting, and standing or walking) by a cohort of hospitalized older veterans as measured by validated wireless ...accelerometers.
DESIGN: A prospective, observational cohort study.
SETTING: One hundred fifty–bed Department of Veterans Affairs hospital.
PARTICIPANTS: Forty‐five hospitalized medical patients, aged 65 and older who were not delirious, did not have dementia, and were able to walk in the 2 weeks before admission were eligible.
MEASUREMENTS: Wireless accelerometers were attached to the thigh and ankle of patients for the first 7 days after admission or until hospital discharge, whichever came first. The mean proportion of time spent lying, sitting, and standing or walking was determined for each hour after hospital admission using a previously validated algorithm.
RESULTS: Forty‐five male patients (mean age 74.2) with a mean length of stay of 5.1 days generated 2,592 one‐hour periods of data. A baseline functional assessment indicated that 35 (77.8%) study patients were willing and able to walk a short distance independently. No patient remained in bed the entire measured hospital stay, but on average, 83% of the measured hospital stay was spent lying in bed. The average amount of time that any one individual spent standing or walking ranged from a low of 0.2% to a high of 21%, with a median of 3%, or 43 minutes per day.
CONCLUSION: This is the first study to continuously monitor mobility levels early during a hospital stay. On average, older hospitalized patients spent most of their time lying in bed, despite an ability to walk independently.
Full text
Available for:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Cynthia J. Brown explains why the advent of print in the late medieval period brought about changes in relationships among poets, patrons, and printers which led to a new conception of authorship. ...Examining such paratextual elements of manuscripts as title pages, colophons, and illustrations as well as such literary strategies as experimentation with narrative voice, Brown traces authors' attempts to underscore their narrative presence in their works and to displace patrons from their role as sponsors and protectors of the book. Her accounts of the struggles of poets, including Jean Lemaire, Jean Bouchet, Jean Molinet, and Pierre Gringore, over the design, printing, and sale of their books demonstrate how authors secured the status of literary proprietor during the transition from the culture of script and courtly patronage to that of print capitalism.
Objectives
To identify trajectories of recovery of community mobility in acutely ill older adults using the University of Alabama at Birmingham Life‐Space Assessment (LSA).
Design
Prospective ...observation cohort study.
Setting
Central Alabama, Birmingham Veterans Affairs Medical Center.
Participants
Community‐dwelling adults aged 65 and older hospitalized for nonsurgical medical reasons (N=173).
Measurements
We determined LSA scores for the month before and monthly for 6 months after hospitalization (composite scores ranging from 0–120, with 120 reflecting completely unrestricted mobility).
Results
In the month after hospitalization, 92 (53%) participants had a clinically significant decrease in life‐space mobility, while 42 (24%) were unchanged, and 39 (23%) had an increase from the month preceding hospitalization. Of participants with a life‐space decrease, the majority recovered their prehospitalization mobility status during 6 months of follow‐up, whereas 34% did not recover. Participants whose life‐space decreased were hospitalized significantly longer (P=.01) and, on average, had higher prehospital life‐space scores (P=.01) than those who maintained or increased their life‐space.
Conclusion
A clinically significant loss of community mobility was common after hospitalization, but most participants recovered to prehospitalization mobility within 6 months of discharge. Research examining in‐hospital and posthospitalization interventions to achieve faster recovery of community mobility is needed.
Full text
Available for:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Abstract Purpose The study purpose was to assess the effects of emergency department visits on mobility as measured by Life-Space Assessment (LSA) scores and to compare life-space trajectories ...associated with emergency department visit only, hospitalization, and no event. Methods A total of 410 community-dwelling adults aged ≥75 years who were living in the community, were able to communicate by telephone, could schedule an in-home interview, and could answer questions independently were followed from June 2010 to August 2014. In-home baseline and monthly telephone follow-up interviews collected data on LSA scores, emergency department use, and hospitalizations. Life-space is measured using a validated patient-reported tool reflecting community mobility and quality of life. Trajectories of LSA before and after an emergency department visit or hospitalization were compared with no event occurrence. Results Mean age of participants was 81.7 years (standard deviation, 4.8); 57% were female, and 35% were African American. During 3 years of follow-up, 83 persons (20%) had an emergency department visit without subsequent hospitalization and 164 persons (40%) were hospitalized. Although baseline LSA scores were similar, in the month after an emergency department visit, adjusted LSA scores decreased by 6.1 points ( P = .01) in comparison with hospitalized participants who experienced an average decrease of 18.0 points ( P < .0001). Neither those with an emergency department visit only nor those with hospitalization recovered to their prior level of community mobility. Moreover, those with an emergency department visit showed no significant improvement in LSA scores up to 1 year later. Conclusions Older adults who experienced an emergency department visit or hospitalization had an associated decrease in community mobility without significant recovery.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
IMPORTANCE: Low mobility is common during hospitalization and associated with loss or declines in ability to perform activities of daily living (ADL) and limitations in community mobility. OBJECTIVE: ...To examine the effect of an in-hospital mobility program (MP) on posthospitalization function and community mobility. DESIGN, SETTING, AND PARTICIPANTS: This single-blind randomized clinical trial used masked assessors to compare a MP with usual care (UC). Patients admitted to the medical wards of the Birmingham Veterans Affairs Medical Center from January 12, 2010, through June 29, 2011, were followed up throughout hospitalization with 1-month posthospitalization telephone follow-up. One hundred hospitalized patients 65 years or older were randomly assigned to the MP or UC groups. Patients were cognitively intact and able to walk 2 weeks before hospitalization. Data analysis was performed from November 21, 2012, to March 14, 2016. INTERVENTIONS: Patients in the MP group were assisted with ambulation up to twice daily, and a behavioral strategy was used to encourage mobility. Patients in the UC group received twice-daily visits. MAIN OUTCOMES AND MEASURES: Changes in self-reported ADL and community mobility were assessed using the Katz ADL scale and the University of Alabama at Birmingham Study of Aging Life-Space Assessment (LSA), respectively. The LSA measures community mobility based on the distance through which a person reports moving during the preceding 4 weeks. RESULTS: Of 100 patients, 8 did not complete the study (6 in the MP group and 2 in the UC group). Patients (mean age, 73.9 years; 97 male 97.0%; and 19 black 19.0%) had a median length of stay of 3 days. No significant differences were found between groups at baseline. For all periods, groups were similar in ability to perform ADL; however, at 1-month after hospitalization, the LSA score was significantly higher in the MP (LSA score, 52.5) compared with the UC group (LSA score, 41.6) (P = .02). For the MP group, the 1-month posthospitalization LSA score was similar to the LSA score measured at admission. For the UC group, the LSA score decreased by approximately 10 points. CONCLUSIONS AND RELEVANCE: A simple MP intervention had no effect on ADL function. 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. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00715962
Life‐Space Mobility Change Predicts 6‐Month Mortality Kennedy, Richard E.; Sawyer, Patricia; Williams, Courtney P. ...
Journal of the American Geriatrics Society (JAGS),
April 2017, Volume:
65, Issue:
4
Journal Article
Peer reviewed
Open access
Objectives
To examine 6‐month change in life‐space mobility as a predictor of subsequent 6‐month mortality in community‐dwelling older adults.
Design
Prospective cohort study.
Setting
...Community‐dwelling older adults from five Alabama counties in the University of Alabama at Birmingham (UAB) Study of Aging.
Participants
A random sample of 1,000 Medicare beneficiaries, stratified according to sex, race, and rural or urban residence, recruited between November 1999 and February 2001, followed by a telephone interview every 6 months for the subsequent 8.5 years.
Measurements
Mortality data were determined from informant contacts and confirmed using the National Death Index and Social Security Death Index. Life‐space was measured at each interview using the UAB Life‐Space Assessment, a validated instrument for assessing community mobility. Eleven thousand eight hundred seventeen 6‐month life‐space change scores were calculated over 8.5 years of follow‐up. Generalized linear mixed models were used to test predictors of mortality at subsequent 6‐month intervals.
Results
Three hundred fifty‐four deaths occurred within 6 months of two sequential life‐space assessments. Controlling for age, sex, race, rural or urban residence, and comorbidity, life‐space score and life‐space decline over the preceding 6‐month interval predicted mortality. A 10‐point decrease in life‐space resulted in a 72% increase in odds of dying over the subsequent 6 months (odds ratio = 1.723, P < .001).
Conclusions
Life‐space score at the beginning of a 6‐month interval and change in life‐space over 6 months were each associated with significant differences in subsequent 6‐month mortality. Life‐space assessment may assist clinicians in identifying older adults at risk of short‐term mortality.
Full text
Available for:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
PDF
