This study examines physical activity during and after hospitalization in acutely hospitalized older adults and its association with hospital-associated disability (HAD). Older adults have low levels of physical activity during acute hospitalization, which is associated with an increased risk of HAD. HAD is a decline in the ability to perform activities of daily living that occurs in relation to hospitalization and cannot be explained by the acute illness alone. HAD affects up to 30% of acutely hospitalized older adults and is associated with adverse outcomes, including an increased risk of discharge to a nursing home, readmission, and mortality. Furthermore, patients who develop HAD are at risk of not regaining their pre-admission functional level and experiencing persistent functional decline after discharge. Physical activity and exercise are recommended as strategies to prevent HAD. However, many acutely hospitalized older adults have limited capacity or motivation to engage in structured exercise. It therefore remains unclear how much physical activity during hospitalization is sufficient to reduce the risk of HAD and which types of physical activity patients are able and prefer to perform. The study will also examine patients' ability and preferences for different types of physical activity during hospitalization and explore their motivation, barriers, and preferences for physical activity after discharge. The results may help identify clinically relevant levels of physical activity during hospitalization and contribute to more patient-centered approaches to supporting physical activity and preventing functional decline during and after hospitalization.
This study is a prospective cohort study investigating physical activity, functioning, and hospital-associated disability (HAD) in acutely hospitalized older adults. The study also examines patients' ability, preferences, motivation, and barriers related to physical activity during hospitalization and after discharge. Physical activity levels are generally low among older adults during acute hospitalization and are associated with an increased risk of HAD. Physical activity and exercise are recommended as strategies to prevent functional decline during hospitalization. However, there is currently no clear threshold for how much physical activity is needed to reduce the risk of HAD. Furthermore, many acutely hospitalized older adults have limited capacity or motivation to engage in structured exercise, highlighting the need to understand which forms and levels of physical activity are both clinically relevant and feasible from the patients' perspective. The study will include 170 adults aged 65 years or older who are acutely admitted to the Department of Geriatrics or the Department of Cardiology at Copenhagen University Hospital - Hvidovre. Participants will be consecutively recruited within 48 hours of admission and followed during hospitalization and at 1, 4, and 8 weeks after discharge. During hospitalization: At inclusion, participants will undergo a baseline assessment consisting of clinical tests and questionnaires assessing functioning, mobility, frailty, health literacy, general health, physical activity, and demographic characteristics. 24-hour physical activity will be objectively measured using SENS motion® sensor technology. The sensor will be worn continuously during hospitalization and will provide information on daily step count and time spent walking, standing, sitting, and lying down. Self-reported mobility during hospitalization will additionally be assessed using the Danish version of the Acute Care Mobility Assessment (ACMA-DK). During hospitalization participants' imagined and actual ability to perform different forms of physical activity will also be assessed, together with their preferences, motivation, and barriers related to physical activity. Participants will be asked to evaluate and perform two clinically relevant activity types: hallway walking and resistance exercise. They will also be asked about their preference for group-based functional training. 1 week after discharge: Participants will be contacted by telephone to assess functioning and the development of HAD following hospitalization. 4 weeks after discharge: Participants will be contacted by telephone to reassess functioning and whether functional decline following hospitalization persists. 8 weeks after discharge: An 8-week follow-up assessment will be conducted in the participant's home. Physical activity after discharge will be objectively measured using SENS motion® sensor technology for seven consecutive days prior to the 8-week follow-up. At the follow-up visit, physical function, mobility, and the development or persistence of HAD will be assessed. A qualitative study is embedded within the prospective cohort to explore patients' experiences and perspectives on physical activity after discharge. Participants will be recruited among patients who have completed the 8-week follow-up. Semi-structured interviews will explore motivation, barriers, and preferences related to physical activity after discharge, as well as experiences with rehabilitation. The overall aim of the project is to integrate objectively measured physical activity patterns, clinical measures of functioning, and patients' own experiences and preferences to contribute to the development of a practice-oriented and patient-centered approach to preventing HAD in acutely hospitalized older adults.
Study Type
OBSERVATIONAL
Enrollment
170
Participants will receive standard care throughout hospitalization. In addition to standard care, participants will take part in a single supervised assessment of their ability and preferences for different types of physical activity. The assessment includes hallway walking (200 steps, with walking aids or assistance if needed) and resistance exercise consisting of three sets of 8-12 repetition maximum sit-to-stands. Participants will also be asked about their preference for group-based functional training and about their motivation and barriers related to physical activity. Physical activity will be objectively measured using SENS motion® sensor technology continuously during hospitalization and for seven consecutive days prior to the 8-week follow-up after discharge. Self-reported mobility during hospitalization will also be assessed. After discharge, participants' experiences, motivation, barriers, and preferences related to physical activity and rehabilitation will be explored th
Copenhagen University Hospital, Hvidovre
Hvidovre, Denmark
Hospital-associated disability
Hospital-associated disability (HAD) is defined as a new decline in functional independence in at least one activity compared with the participant's pre-admission level. Functional independence is assessed using three components: six basic activities of daily living from the Katz Index (bathing, dressing, toileting, transferring, continence, and feeding); five instrumental activities of daily living inspired by the Lawton IADL Index (shopping, housekeeping, laundry, food preparation, and medication management); and four mobility-related activities (walking 400 meters without rest, climbing or descending one flight of stairs without rest, carrying 5 kg, and driving a car). Each activity is scored as unable to perform (0), able to perform with assistance (1), or able to perform independently (2). Participants with a decline in independence in at least one activity compared with their retrospectively assessed pre-admission level are classified as having HAD.
Time frame: At inclusion and 1, 4 and 8 weeks after discharge
Imagined ability to perform physical activity during hospitalization
Participants' imagined ability to perform physical activity during hospitalization will be assessed by asking whether they can imagine performing the activity daily during hospitalization. Imagined ability will be assessed for hallway walking (200 steps) and resistance exercise (three sets of 8-12 sit-to-stand repetitions) and group-based functionel training.
Time frame: At inclusion
Actual ability to perform physical activity during hospitalization
Participants' actual ability to perform physical activity during hospitalization will be assessed by asking them to perform hallway walking (200 steps) and resistance exercise (three sets of 8-12 sit-to-stand repetitions). For each activity, actual ability will be categorized as able to complete the activity as defined, 0) unable to complete the activity, 1) able to complete the activity with assistance and 2) able to complete the activity independently. Reasons for inability to complete an activity will be recorded.
Time frame: At inclusion
Preferred type of physical activity during hospitalization
Participants will be asked which type of physical activity they prefer: hallway walking, resistance training and group-based functional training. (Group-based functional training will be assessed as a preference only and will not be physically performed as part of the assessment).
Time frame: At inclusion
Mean Daily steps
Number of daily steps assessed by a SENS motion® accelerometer worn continuously from inclusion and throughout hospitalization and for seven consecutive days prior to the 8-week follow-up after discharge. A measurement day is considered valid if more than 20 hours of 24-hour mobility data are available. For each participant, mean daily step count is calculated across all available valid days within each measurement period.
Time frame: From inclusion through hospital discharge, an average of 5 days; and 7 consecutive days before the 8-week follow-up
Mean daily uptime
Daily time spent in uptime assessed by a SENS motion® accelerometer worn continuously from inclusion and throughout hospitalization and for seven consecutive days prior to the 8-week follow-up after discharge. A measurement day is considered valid if more than 20 hours of 24-hour mobility data are available. For each participant, mean daily step count is calculated across all available valid days within each measurement period.
Time frame: From inclusion through hospital discharge, an average of 5 days; and 7 consecutive days before the 8-week follow-up
Mean daily walking
Daily time spent walking assessed by a SENS motion® accelerometer worn continuously from inclusion and throughout hospitalization and for seven consecutive days prior to the 8-week follow-up after discharge. A measurement day is considered valid if more than 20 hours of 24-hour mobility data are available. For each participant, mean daily step count is calculated across all available valid days within each measurement period.
Time frame: From inclusion through hospital discharge, an average of 5 days; and 7 consecutive days before the 8-week follow-up
Mean daily standing
Daily time spent standing assessed by a SENS motion® accelerometer worn continuously from inclusion and throughout hospitalization and for seven consecutive days prior to the 8-week follow-up after discharge. A measurement day is considered valid if more than 20 hours of 24-hour mobility data are available. For each participant, mean daily step count is calculated across all available valid days within each measurement period.
Time frame: From inclusion through hospital discharge, an average of 5 days; and 7 consecutive days before the 8-week follow-up
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Mean daily lying/sitting
Daily time spent sitting or lying assessed by a SENS motion® accelerometer worn continuously from inclusion and throughout hospitalization and for seven consecutive days prior to the 8-week follow-up after discharge. A measurement day is considered valid if more than 20 hours of 24-hour mobility data are available. For each participant, mean daily step count is calculated across all available valid days within each measurement period.
Time frame: From inclusion through hospital discharge, an average of 5 days; and 7 consecutive days before the 8-week follow-up