Posture, Mobility, and 30-Day Hospital Readmission and Function in Older Adults with Heart Failure

Abstract

Introduction: Session participants will be able to describe the relationship between hospital posture/ambulation and readmission status and functional outcomes at 30 days in a sample of older adults with heart failure. Background: Heart failure is the leading cause of hospitalization in older adults and has the highest 30-day readmission rate of all diagnoses. An estimated 30 to 60 percent of older adults lose some degree of physical function during the course of an acute hospital stay. Few studies have addressed the role of posture and ambulation in contributing to, or improving, physical function in older hospitalized adults. No study to date has addressed this specifically in the older heart failure population. Purpose: To investigate the predictive value of posture and ambulation during a hospital stay and patterns of ambulation during the month following discharge on hospital readmission and 30-day changes in functional status in older heart failure patients. Methods: This was a prospective observational study of 27 older (ages 62 + years) hospital patients admitted with a primary diagnosis of heart failure. During hospitalization, participants wore continuously two inclinometric accelerometers (rib area and thigh) to record posture and an accelerometer placed at the ankle to record ambulatory activity. Participants continued to wear the ankle accelerometer for 30 days after hospital discharge. Function was assessed for all patients the day after hospital discharge (Timed Up and Go test [TUG], Short Performance Physical Battery test [SPPB], hand grip strength) and again at 30 days post-discharge. Results: Mean participant age was 78.0 ± 9.8 (51.8% female) with a mean length of stay of 5.1 ± 3.9 days (median 3.9 days). Participants spent (M ± SD) 63.0 ± 19.2 percent of their hospital time lying, 30.2 ± 18.7 percent sitting, 5.3 ± 4.2 percent standing, and 1.9 ± 8.6 percent ambulating. Thirty-day post-discharge stepping (M ± SD) was 4890 ± 2285. Five patients (18.5%) were readmitted within the 30 day post-discharge period. None of the hospital or post-discharge mobility measures were associated with readmission after adjustment for covariates. Higher percent lying time in the hospital was associated with slower TUG time (b = .08 [95% CI .03, .14], P = .02). Higher average daily stepping during the post-discharge period was associated with improvements in SPPB scores at 30 days post-discharge (b = .001 [95% CI .00, .001], P < .001). Conclusion: In this sample of older heart failure patients, increased time lying while hospitalized was associated with decreased functional performance. Higher daily stepping in the early post-discharge period was associated with improvements in physical function at 30 days. Findings from this and similar studies should be used to inform interventions targeting patient care practices to improve mobility care and support of older adults hospitalized with medical illnesses such as heart failure.