TY - JOUR
T1 - Factors Associated with Step Numbers in Acutely Hospitalized Older Adults
T2 - The Hospital-Activities of Daily Living Study
AU - Hospital-ADL study group
AU - Kolk, Daisy
AU - Aarden, Jesse J.
AU - MacNeil-Vroomen, Janet L.
AU - Reichardt, Lucienne A.
AU - van Seben, Rosanne
AU - van der Schaaf, Marike
AU - van der Esch, Martin
AU - Twisk, Jos W.R.
AU - Bosch, Jos A.
AU - Buurman, Bianca M.
AU - Engelbert, Raoul H.H.
N1 - Funding Information: This study is funded by the Netherlands Organisation for Health Research and Development (NWO-ZonMw), grant number 16156071 . Funding Information: This study is funded by the Netherlands Organisation for Health Research and Development (NWO-ZonMw), grant number 16156071. Publisher Copyright: © 2020 AMDA – The Society for Post-Acute and Long-Term Care Medicine Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/2
Y1 - 2021/2
N2 - Objectives: To determine the number of steps taken by older patients in hospital and 1 week after discharge; to identify factors associated with step numbers after discharge; and to examine the association between functional decline and step numbers after discharge. Design: Prospective observational cohort study conducted in 2015–2017. Setting and Participants: Older adults (≥70 years of age) acutely hospitalized for at least 48 hours at internal, cardiology, or geriatric wards in 6 Dutch hospitals. Methods: Steps were counted using the Fitbit Flex accelerometer during hospitalization and 1 week after discharge. Demographic, somatic, physical, and psychosocial factors were assessed during hospitalization. Functional decline was determined 1 month after discharge using the Katz activities of daily living index. Results: The analytic sample included 188 participants [mean age (standard deviation) 79.1 (6.7)]. One month postdischarge, 33 out of 174 participants (19%) experienced functional decline. The median number of steps was 656 [interquartile range (IQR), 250–1146] at the last day of hospitalization. This increased to 1750 (IQR 675–4114) steps 1 day postdischarge, and to 1997 (IQR 938–4098) steps 7 days postdischarge. Age [β = −57.93; 95% confidence interval (CI) −111.15 to −4.71], physical performance (β = 224.95; 95% CI 117.79–332.11), and steps in hospital (β = 0.76; 95% CI 0.46–1.06) were associated with steps postdischarge. There was a significant association between step numbers after discharge and functional decline 1 month after discharge (β = −1400; 95% CI –2380 to −420; P =.005). Conclusions and Implications: Among acutely hospitalized older adults, step numbers double 1 day postdischarge, indicating that their capacity is underutilized during hospitalization. Physical performance and physical activity during hospitalization are key to increasing the number of steps postdischarge. The number of steps 1 week after discharge is a promising indicator of functional decline 1 month after discharge.
AB - Objectives: To determine the number of steps taken by older patients in hospital and 1 week after discharge; to identify factors associated with step numbers after discharge; and to examine the association between functional decline and step numbers after discharge. Design: Prospective observational cohort study conducted in 2015–2017. Setting and Participants: Older adults (≥70 years of age) acutely hospitalized for at least 48 hours at internal, cardiology, or geriatric wards in 6 Dutch hospitals. Methods: Steps were counted using the Fitbit Flex accelerometer during hospitalization and 1 week after discharge. Demographic, somatic, physical, and psychosocial factors were assessed during hospitalization. Functional decline was determined 1 month after discharge using the Katz activities of daily living index. Results: The analytic sample included 188 participants [mean age (standard deviation) 79.1 (6.7)]. One month postdischarge, 33 out of 174 participants (19%) experienced functional decline. The median number of steps was 656 [interquartile range (IQR), 250–1146] at the last day of hospitalization. This increased to 1750 (IQR 675–4114) steps 1 day postdischarge, and to 1997 (IQR 938–4098) steps 7 days postdischarge. Age [β = −57.93; 95% confidence interval (CI) −111.15 to −4.71], physical performance (β = 224.95; 95% CI 117.79–332.11), and steps in hospital (β = 0.76; 95% CI 0.46–1.06) were associated with steps postdischarge. There was a significant association between step numbers after discharge and functional decline 1 month after discharge (β = −1400; 95% CI –2380 to −420; P =.005). Conclusions and Implications: Among acutely hospitalized older adults, step numbers double 1 day postdischarge, indicating that their capacity is underutilized during hospitalization. Physical performance and physical activity during hospitalization are key to increasing the number of steps postdischarge. The number of steps 1 week after discharge is a promising indicator of functional decline 1 month after discharge.
KW - Accelerometer
KW - hospitalization
KW - older adults
KW - physical performance
KW - post-acute care
KW - postdischarge
UR - http://www.scopus.com/inward/record.url?scp=85088363758&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jamda.2020.06.027
DO - https://doi.org/10.1016/j.jamda.2020.06.027
M3 - Article
C2 - 32713773
SN - 1525-8610
VL - 22
SP - 425
EP - 432
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 2
ER -