010Barriers to Older Medical Patient Walking in Hospital

Abstract

Background: We aimed to identify patient-and time-specific barriers to walking among older medical inpatients. Methods: 154 medical inpatients aged ≥65 years, premorbidly mobile, with an anticipated length of stay ≥3 days, were recruited. Step-count (Stepwatch Activity Monitor) and potential barriers to walking were recorded daily until discharge or for a maximum of five weekdays. These included medical status, walking ability, presence of catheters and intravenous lines, agitation or confusion, reported fatigue, pain, fear of falling, and instructed bedrest. Linear mixed effects models were used to measure the associations between log-transformed daily step-count and potential barriers, adjusted for each other, and key patient characteristics on admission: age, sex, height, weight, physical performance (SPPB), number of medications, and illness severity (CIRS-G). Due to missing data, the analytical sample included 147 patients. Results: In the fully adjusted mixed effects model, step-count increased linearly by an average of 12% (95% CI 2% to 23%) for each day of observation. However, the mixed effects model with patient-level random intercept and slope factors fit the data better than the random intercept model (p < 0.001), or the model with no random effects (p < 0.001), suggesting there was considerable patient-level variability in step-count trajectories. Among time-varying predictors, the ability to walk independently was associated with a 46% increase in daily step-count (95% CI 12% to 91%); while a decrease in daily step-count was linked to fear of falling (.27%; 95% CI ≥46% to ≥1%), being tethered to the bed (.21%; 95% CI ≥39% to + 3%), and instructed bedrest (.68%; 95% CI ≥78% to ≥47%). Conclusion: Daily step-count trajectories were variable, even when adjusted for patient characteristics on admission. The results suggested that patients tethered to the bed, unable to walk independently, and fear of falling may require more support to walk in hospital.