49A Review of Outdoor Mobility in a Geriatric Rehabilitation Unit

Abstract

Background: Outdoor-walking requires a higher level of motor control as well as cognitive flexibility to address motor requirements while attending to a range of environmental stimuli or concurrent tasks. It is associated with greater feelings of positive engagement, decreased tension and depression, increased community participation and improved quality of life. Despite these overwhelming benefits, little or no research/guidelines exist in its promotion especially in over 65s to warrant change in current practice. Aim(s): (1) examine the prevalence of patients with outdoor mobility on initial assessment and discharge (2) examine current physiotherapy practice regarding outdoor mobility retraining (3) examine contributory factors to loss of outdoor mobility post rehabilitation Methods: A randomized retrospective study of patients discharged from a geriatric rehabilitation ward between October 2016 and October 2017. Physical function was assessed using the Berg Balance Scale (BBS), cut-off < 45. Cognitive impairment (CI) was assessed using validated cognitive tools (ACE < 82, MMSE < 24, MOCA < 26, RUDAS < 23) and living status documented. Outdoor mobility retraining process was examined. Data was analysed to answer audit aims. Result(s): 39 medical charts were audited. 64% were female, 36% male with a mean age of 83 years. 76% had baseline outdoor mobility, 47% were retrained and discharged with outdoor mobility. Of those who did not have outdoor mobility on discharge, findings indicate multifactorial reasons for lack of outdoor mobility; reduced BBS (95%), CI (91%) and living alone (71%). All but one patient presented with at least 2 of the factors mentioned, with 62% presenting with all 3. Conclusion(s): Almost 50% of patients with baseline outdoor mobility were retrained in the form of simulated obstacle course walking followed by outdoor mobility practice. Lack of outdoor mobility on discharge was multi-factorial. There was no documentation of education/promotion of outdoor mobility with family members/carers in those who were deemed dependent in outdoor mobility.