Objectives To objectively assess total steps and minutes active in the first and last 24 hours of hospitalization and to examine associations with survival after discharge in hospitalized older adults. Design A prospective study. Setting A 20‐bed Acute Care for Elders (ACE) hospital unit. Participants Two hundred twenty‐four older adults admitted to an ACE hospital unit. Measurements An activity monitor was used to collect information on total steps and minutes of activity in the first and last 24 hours of hospitalization. The main outcome was 2‐year survival from hospital discharge date. Results Participants were active for approximately 80 minutes in the first 24 hours of hospitalization. Participants aged 65–84 were active approximately 28 minutes more in the last 24 hours of hospitalization, but activity levels were essentially unchanged for those aged 85 and older. The median step count for participants was low, with a median of 478 steps in the first 24 hours of hospitalization and 846 in the last 24 hours. Multivariate survival models showed that, in the first and last 24 hours of hospitalization, each 100‐step increase was associated with a 2% (hazard ratio (HR) = 0.98, 95% confidence interval (CI) = 0.96–1.00) and 3% (HR = 0.97, 95% CI = 0.94–0.99) lower risk of death over 2 years, respectively. A decline in steps from first to last 24 hours of hospitalization was associated with a more than four times greater risk of death (HR = 4.21, 95% CI = 1.65–10.77) 2 years after discharge. Conclusion Accelerometers could provide meaningful information about walking activity. The ability to apply objective information about the individual's functional status to improve the delivery of health care and health outcomes is important.