Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 152 No. 4950 (2022)

Steps parameters of elderly patients hospitalised for an acute medical illness in a Swiss University Hospital: an observational pilot study

  • Francesco Tommasini
  • Pedro Marques-Vidal
  • Bengt Kayser
  • Plamena Tasheva
  • Anisoara Ionescu
  • Marie Méan
DOI
https://doi.org/10.57187/smw.2022.40012
Cite this as:
Swiss Med Wkly. 2022;152:40012
Published
15.12.2022

Summary

BACKGROUND: Objective mobility goals for elderly hospitalised medical patients remain debated. We therefore studied steps parameters of elderly patients hospitalised for an acute illness, to determine goals for future interventional trials and medical practice.

METHODS: Observational study conducted from February to November 2018 in a medical ward of the Lausanne University Hospital, Switzerland. We measured the step parameters of consecutive medical patients aged ≥65 years admitted for an acute medical illness using a wrist accelerometer (Geneactiv). We also collected demographic, somatic and functional factors.

RESULTS: Overall, 187 inpatients had their step parameters (daily step count, walking cadence and bout duration) measured with accelerometers worn for a mean of 3.6 days (standard deviation [SD] 3.2). Elderly inpatients (81.5 years, SD 8.5) walked a median of 603 steps daily (interquartile range [IQR] 456–809), at a median cadence of 100 steps/minute (IQR 99–101) with median walking bouts of 33 seconds (IQR 27–37) and with 70% of the walking bouts lasting less than 30 seconds. Patients walking ≥600 steps were younger (80.4 years, SD 8.9 vs 82.8 years,SD 7.9, p = 0.050) and had a longer length of stay (7.8 days, SD 5.1 vs 6.1 days, SD 4.1, p = 0.011) than those walking <600 steps. Patients at high risk of bed sores walked less (564 steps, IQR 394–814 vs 626, IQR 526–840) than those with a lower risk of sores.

CONCLUSION: During a hospitalisation for an acute medical illness, patients aged ≥65 years walk a mere 603 steps daily and most of the time for periods of less than 30 seconds. This information should be used to build up future interventional trials or to set mobility goals for patients hospitalised in Swiss hospitals.

References

  1. Morris JN, Hardman AE. Walking to health. Sports Med. 1997 May;23(5):306–32. https://doi.org/https://doi.org.10.2165/00007256-199723050-00004 DOI: https://doi.org/10.2165/00007256-199723050-00004
  2. Lee IM, Buchner DM. The importance of walking to public health. Med Sci Sports Exerc. 2008 Jul;40(7 Suppl):S512–8. https://doi.org/https://doi.org.10.1249/MSS.0b013e31817c65d00195-9131 https://doi.org/https://doi.org.10.1249/MSS.0b013e31817c65d0
  3. Brown CJ, Redden DT, Flood KL, Allman RM. The underrecognized epidemic of low mobility during hospitalization of older adults. J Am Geriatr Soc. 2009 Sep;57(9):1660–5. https://doi.org/https://doi.org.10.1111/j.1532-5415.2009.02393.x DOI: https://doi.org/10.1111/j.1532-5415.2009.02393.x
  4. Brown CJ, Williams BR, Woodby LL, Davis LL, Allman RM. Barriers to mobility during hospitalization from the perspectives of older patients and their nurses and physicians. J Hosp Med. 2007 Sep;2(5):305–13. https://doi.org/https://doi.org.10.1002/jhm.209 DOI: https://doi.org/10.1002/jhm.209
  5. Pedersen MM, Bodilsen AC, Petersen J, Beyer N, Andersen O, Lawson-Smith L, et al. Twenty-four-hour mobility during acute hospitalization in older medical patients. J Gerontol A Biol Sci Med Sci. 2013 Mar;68(3):331–7. https://doi.org/https://doi.org.10.1093/gerona/gls165 DOI: https://doi.org/10.1093/gerona/gls165
  6. Tasheva P, Kraege V, Vollenweider P, Roulet G, Méan M, Marques-Vidal P. Accelerometry assessed physical activity of older adults hospitalized with acute medical illness - an observational study. BMC Geriatr. 2020 Oct;20(1):382. https://doi.org/https://doi.org.10.1186/s12877-020-01763-w DOI: https://doi.org/10.1186/s12877-020-01763-w
  7. Brown CJ, Friedkin RJ, Inouye SK. Prevalence and outcomes of low mobility in hospitalized older patients. J Am Geriatr Soc. 2004 Aug;52(8):1263–70. https://doi.org/https://doi.org.10.1111/j.1532-5415.2004.52354.x DOI: https://doi.org/10.1111/j.1532-5415.2004.52354.x
  8. Zisberg A, Shadmi E, Sinoff G, Gur-Yaish N, Srulovici E, Admi H. Low mobility during hospitalization and functional decline in older adults. J Am Geriatr Soc. 2011 Feb;59(2):266–73. https://doi.org/https://doi.org.10.1111/j.1532-5415.2010.03276.x DOI: https://doi.org/10.1111/j.1532-5415.2010.03276.x
  9. Zisberg A, Shadmi E, Gur-Yaish N, Tonkikh O, Sinoff G. Hospital-associated functional decline: the role of hospitalization processes beyond individual risk factors. J Am Geriatr Soc. 2015 Jan;63(1):55–62. https://doi.org/https://doi.org.10.1111/jgs.13193 DOI: https://doi.org/10.1111/jgs.13193
  10. Hoyer EH, Young DL, Friedman LA, Brotman DJ, Klein LM, Friedman M, et al. Routine Inpatient Mobility Assessment and Hospital Discharge Planning. JAMA Intern Med. 2019 Jan;179(1):118–20. https://doi.org/https://doi.org.10.1001/jamainternmed.2018.5145 DOI: https://doi.org/10.1001/jamainternmed.2018.5145
  11. Tasheva P, Vollenweider P, Kraege V, Roulet G, Lamy O, Marques-Vidal P, et al. Association Between Physical Activity Levels in the Hospital Setting and Hospital-Acquired Functional Decline in Elderly Patients. JAMA Netw Open. 2020 Jan;3(1):e1920185. https://doi.org/https://doi.org.10.1001/jamanetworkopen.2019.20185 DOI: https://doi.org/10.1001/jamanetworkopen.2019.20185
  12. Boyd CM, Landefeld CS, Counsell SR, Palmer RM, Fortinsky RH, Kresevic D, et al. Recovery of activities of daily living in older adults after hospitalization for acute medical illness. J Am Geriatr Soc. 2008 Dec;56(12):2171–9. https://doi.org/https://doi.org.10.1111/j.1532-5415.2008.02023.x DOI: https://doi.org/10.1111/j.1532-5415.2008.02023.x
  13. Godfrey A, Conway R, Meagher D, ÓLaighin G. Direct measurement of human movement by accelerometry. Med Eng Phys. 2008 Dec;30(10):1364–86. https://doi.org/https://doi.org.10.1016/j.medengphy.2008.09.005 DOI: https://doi.org/10.1016/j.medengphy.2008.09.005
  14. Fisher SR, Goodwin JS, Protas EJ, Kuo YF, Graham JE, Ottenbacher KJ, et al. Ambulatory activity of older adults hospitalized with acute medical illness. J Am Geriatr Soc. 2011 Jan;59(1):91–5. https://doi.org/https://doi.org.10.1111/j.1532-5415.2010.03202.x DOI: https://doi.org/10.1111/j.1532-5415.2010.03202.x
  15. Lim SE, Dodds R, Bacon D, Sayer AA, Roberts HC. Physical activity among hospitalised older people: insights from upper and lower limb accelerometry. Aging Clin Exp Res. 2018 Nov;30(11):1363–9. https://doi.org/https://doi.org.10.1007/s40520-018-0930-0 DOI: https://doi.org/10.1007/s40520-018-0930-0
  16. Kolk D, Aarden JJ, MacNeil-Vroomen JL, Reichardt LA, van Seben R, van der Schaaf M, et al.; Hospital-ADL Study Group. Factors Associated with Step Numbers in Acutely Hospitalized Older Adults: The Hospital-Activities of Daily Living Study. J Am Med Dir Assoc. 2021 Feb;22(2):425–32. https://doi.org/https://doi.org.10.1016/j.jamda.2020.06.027 DOI: https://doi.org/10.1016/j.jamda.2020.06.027
  17. Tudor-Locke C, Schuna JM Jr, Barreira TV, Mire EF, Broyles ST, Katzmarzyk PT, et al. Normative steps/day values for older adults: NHANES 2005-2006. J Gerontol A Biol Sci Med Sci. 2013 Nov;68(11):1426–32. https://doi.org/https://doi.org.10.1093/gerona/glt116 DOI: https://doi.org/10.1093/gerona/glt116
  18. Agmon M, Zisberg A, Gil E, Rand D, Gur-Yaish N, Azriel M. Association between 900 steps a day and functional decline in older hospitalized patients. JAMA Intern Med. 2017 Feb;177(2):272–4. https://doi.org/https://doi.org.10.1001/jamainternmed.2016.7266 DOI: https://doi.org/10.1001/jamainternmed.2016.7266
  19. Zisberg A, Agmon M, Gur-Yaish N, Rand D, Hayat Y, Gil E ; WALK-FOR team. No one size fits all-the development of a theory-driven intervention to increase in-hospital mobility: the “WALK-FOR” study. BMC Geriatr. 2018 Apr;18(1):91. https://doi.org/https://doi.org.10.1186/s12877-018-0778-3 DOI: https://doi.org/10.1186/s12877-018-0778-3
  20. Hamilton AC, Lee N, Stilphen M, Hu B, Schramm S, Frost F, et al. Increasing Mobility via In-hospital Ambulation Protocol Delivered by Mobility Technicians: A Pilot Randomized Controlled Trial. J Hosp Med. 2019 May;14(5):272–7. https://doi.org/https://doi.org.10.12788/jhm.3153 DOI: https://doi.org/10.12788/jhm.3153
  21. Pavon JM, Sloane RJ, Pieper CF, Colón-Emeric CS, Gallagher D, Cohen HJ, et al. Physical Activity in the Hospital: Documentation and Influence on Venous Thromboembolism Prophylaxis. J Aging Phys Act. 2020 Apr;28(2):306–10. https://doi.org/https://doi.org.10.1123/japa.2018-0462 DOI: https://doi.org/10.1123/japa.2018-0462
  22. Kolk D, Aarden JJ, MacNeil-Vroomen JL, Reichardt LA, van Seben R, van der Schaaf M, et al.; Hospital-ADL Study Group. Factors Associated with Step Numbers in Acutely Hospitalized Older Adults: The Hospital-Activities of Daily Living Study. J Am Med Dir Assoc. 2021 Feb;22(2):425–32. https://doi.org/https://doi.org.10.1016/j.jamda.2020.06.027 DOI: https://doi.org/10.1016/j.jamda.2020.06.027
  23. Organisation for Economic Co-operation and Development. https://data.oecd.org/health.htm
  24. Esliger DW, Rowlands A, Hurst TL, Catt M, Murray P, Eston RG; ESLIGER DW. ROWLANDS A v., HURST TL, CATT M, MURRAY P, ESTON RG. Validation of the GENEA Accelerometer. Med Sci Sports Exerc. 2011;43(6):1085–93. https://doi.org/https://doi.org.10.1249/MSS.0b013e31820513be DOI: https://doi.org/10.1249/MSS.0b013e31820513be
  25. Rowlands A v., Mirkes EM, Yates T, et al. Accelerometer-assessed physical activity in epidemiology: Are monitors equivalent? Medicine and Science in Sports and Exercise. 2018;50(2). https://doi.org/https://doi.org.10.1249/MSS.0000000000001435 DOI: https://doi.org/10.1249/MSS.0000000000001435
  26. Lim SE, Ibrahim K, Sayer AA, Roberts HC. Assessment of Physical Activity of Hospitalised Older Adults: A Systematic Review. J Nutr Health Aging. 2018;22(3):377–86. https://doi.org/https://doi.org.10.1007/s12603-017-0931-2 DOI: https://doi.org/10.1007/s12603-017-0931-2
  27. Dieu O, Mikulovic J, Fardy PS, Bui-Xuan G, Béghin L, Vanhelst J. Physical activity using wrist-worn accelerometers: comparison of dominant and non-dominant wrist. Clin Physiol Funct Imaging. 2017 Sep;37(5):525–9. https://doi.org/https://doi.org.10.1111/cpf.12337 DOI: https://doi.org/10.1111/cpf.12337
  28. Dillon CB, Fitzgerald AP, Kearney PM, Perry IJ, Rennie KL, Kozarski R, et al. Number of days required to estimate habitual activity using wrist-worn geneActiv accelerometer: A cross-sectional study. PLoS One. 2016 May;11(5):e0109913. https://doi.org/https://doi.org.10.1371/journal.pone.0109913 DOI: https://doi.org/10.1371/journal.pone.0109913
  29. Zhou SM, Hill RA, Morgan K, Stratton G, Gravenor MB, Bijlsma G, et al. Classification of accelerometer wear and non-wear events in seconds for monitoring free-living physical activity. BMJ Open. 2015 May;5(5):e007447. https://doi.org/https://doi.org.10.1136/bmjopen-2014-007447 DOI: https://doi.org/10.1136/bmjopen-2014-007447
  30. Soltani A, Dejnabadi H, Fasel B, Ionescu A, Gubelmann C, Marques-Vidal PM, et al. Locomotion detection and cadence estimation using 3D wrist accelerometer: an in-field validation. Gait Posture. 2017;57:186–7. https://doi.org/https://doi.org.10.1016/j.gaitpost.2017.06.359 DOI: https://doi.org/10.1016/j.gaitpost.2017.06.359
  31. Fasel B, Duc C, Dadashi F, Bardyn F, Savary M, Farine PA, et al. A wrist sensor and algorithm to determine instantaneous walking cadence and speed in daily life walking. Med Biol Eng Comput. 2017 Oct;55(10):1773–85. https://doi.org/https://doi.org.10.1007/s11517-017-1621-2 DOI: https://doi.org/10.1007/s11517-017-1621-2
  32. Soltani A, Paraschiv-Ionescu A, Dejnabadi H, Marques-Vidal P, Aminian K. Real-World Gait Bout Detection Using a Wrist Sensor: An Unsupervised Real-Life Validation. IEEE Access. 2020;8:102883–96. https://doi.org/https://doi.org.10.1109/ACCESS.2020.2998842 DOI: https://doi.org/10.1109/ACCESS.2020.2998842
  33. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83. https://doi.org/https://doi.org.10.1016/0021-9681(87)90171-8 DOI: https://doi.org/10.1016/0021-9681(87)90171-8
  34. Shah S, Vanclay F, Cooper B. Improving the sensitivity of the Barthel Index for stroke rehabilitation. J Clin Epidemiol. 1989;42(8):703–9. https://doi.org/https://doi.org.10.1016/0895-4356(89)90065-6 DOI: https://doi.org/10.1016/0895-4356(89)90065-6
  35. Ohura T, Hase K, Nakajima Y, Nakayama T. Validity and reliability of a performance evaluation tool based on the modified Barthel Index for stroke patients. BMC Med Res Methodol. 2017 Aug;17(1):131. https://doi.org/https://doi.org.10.1186/s12874-017-0409-2 DOI: https://doi.org/10.1186/s12874-017-0409-2
  36. Gill TM, Allore H, Guo Z. The deleterious effects of bed rest among community-living older persons. J Gerontol A Biol Sci Med Sci. 2004 ;59(7):755–61. https://doi.org/https://doi.org.10.1093/gerona/59.7.m755 DOI: https://doi.org/10.1093/gerona/59.7.M755
  37. Bergstrom N, Braden BJ, Laguzza A, Holman V. The braden scale for predicting pressure sore risk. Nurs Res. 1987 Jul-Aug;36(4):205–10. https://doi.org/https://doi.org.10.1097/00006199-198707000-00002 DOI: https://doi.org/10.1097/00006199-198707000-00002
  38. R Core Team. (2021). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL https://www.R-project.org/
  39. Fisher SR, Kuo YF, Graham JE, Ottenbacher KJ, Ostir GV. Early ambulation and length of stay in older adults hospitalized for acute illness. Arch Intern Med. 2010 Nov;170(21):1942–3. https://doi.org/https://doi.org.10.1001/archinternmed.2010.422 DOI: https://doi.org/10.1001/archinternmed.2010.422
  40. Hall KS, Hyde ET, Bassett DR, Carlson SA, Carnethon MR, Ekelund U, et al. Systematic review of the prospective association of daily step counts with risk of mortality, cardiovascular disease, and dysglycemia. Int J Behav Nutr Phys Act. 2020 Jun;17(1):78. https://doi.org/https://doi.org.10.1186/s12966-020-00978-9 DOI: https://doi.org/10.1186/s12966-020-00978-9
  41. Daskivich TJ, Houman J, Lopez M, Luu M, Fleshner P, Zaghiyan K, et al. Association of Wearable Activity Monitors With Assessment of Daily Ambulation and Length of Stay Among Patients Undergoing Major Surgery. JAMA Netw Open. 2019 Feb;2(2):e187673. https://doi.org/https://doi.org.10.1001/jamanetworkopen.2018.7673 DOI: https://doi.org/10.1001/jamanetworkopen.2018.7673
  42. Martinez M, Cerasale M, Baig M, Dugan C, Robinson M, Sweis M, et al. Defining Potential Overutilization of Physical Therapy Consults on Hospital Medicine Services. J Hosp Med. 2021 Aug;16(9):553–5. https://doi.org/https://doi.org.10.12788/jhm.3673 DOI: https://doi.org/10.12788/jhm.3673
  43. Brown JC, Harhay MO, Harhay MN. Walking cadence and mortality among community-dwelling older adults. J Gen Intern Med. 2014 Sep;29(9):1263–9. https://doi.org/https://doi.org.10.1007/s11606-014-2926-6 DOI: https://doi.org/10.1007/s11606-014-2926-6
  44. Tudor-Locke C, Barreira TV, Brouillette RM, Foil HC, Keller JN. Preliminary comparison of clinical and free-living measures of stepping cadence in older adults. J Phys Act Health. 2013 Nov;10(8):1175–80. https://doi.org/https://doi.org.10.1123/jpah.10.8.1175 DOI: https://doi.org/10.1123/jpah.10.8.1175
  45. Jerome GJ, Ko SU, Kauffman D, Studenski SA, Ferrucci L, Simonsick EM. Gait characteristics associated with walking speed decline in older adults: results from the Baltimore Longitudinal Study of Aging. Arch Gerontol Geriatr. 2015 Mar-Apr;60(2):239–43. https://doi.org/https://doi.org.10.1016/j.archger.2015.01.007 DOI: https://doi.org/10.1016/j.archger.2015.01.007
  46. Palese A, Gonella S, Moreale R, Guarnier A, Barelli P, Zambiasi P, et al.; ESAMED Group. Hospital-acquired functional decline in older patients cared for in acute medical wards and predictors: findings from a multicentre longitudinal study. Geriatr Nurs. 2016 May-Jun;37(3):192–9. https://doi.org/https://doi.org.10.1016/j.gerinurse.2016.01.001 DOI: https://doi.org/10.1016/j.gerinurse.2016.01.001
  47. Ummels D, Beekman E, Theunissen K, Braun S, Beurskens AJ. Counting steps in activities of daily living in people with a chronic disease using nine commercially available fitness trackers: cross-sectional validity study. JMIR Mhealth Uhealth. 2018 Apr;6(4):e70. https://doi.org/https://doi.org.10.2196/mhealth.8524 DOI: https://doi.org/10.2196/mhealth.8524
  48. Sardo PM, Guedes JA, Alvarelhão JJ, Machado PA, Melo EM. Pressure ulcer incidence and Braden subscales: retrospective cohort analysis in general wards of a Portuguese hospital. J Tissue Viability. 2018 May;27(2):95–100. https://doi.org/https://doi.org.10.1016/j.jtv.2018.01.002 DOI: https://doi.org/10.1016/j.jtv.2018.01.002
  49. Liu B, Moore JE, Almaawiy U, Chan WH, Khan S, Ewusie J, et al.; MOVE ON Collaboration. Outcomes of Mobilisation of Vulnerable Elders in Ontario (MOVE ON): a multisite interrupted time series evaluation of an implementation intervention to increase patient mobilisation. Age Ageing. 2018 Jan;47(1):112–9. https://doi.org/https://doi.org.10.1093/ageing/afx128 DOI: https://doi.org/10.1093/ageing/afx128
  50. Hoyer EH, Friedman M, Lavezza A, Wagner-Kosmakos K, Lewis-Cherry R, Skolnik JL, et al. Promoting mobility and reducing length of stay in hospitalized general medicine patients: A quality-improvement project. J Hosp Med. 2016 May;11(5):341–7. https://doi.org/https://doi.org.10.1002/jhm.2546 DOI: https://doi.org/10.1002/jhm.2546
  51. Ostir GV, Berges IM, Kuo YF, Goodwin JS, Fisher SR, Guralnik JM. Mobility activity and its value as a prognostic indicator of survival in hospitalized older adults. J Am Geriatr Soc. 2013 ;61(4):551–7. https://doi.org/https://doi.org.10.1111/jgs.121700002-8614 DOI: https://doi.org/10.1111/jgs.12170
  52. Smart DA, Dermody G, Coronado ME, Wilson M. Mobility Programs for the Hospitalized Older Adult: A Scoping Review. Gerontol Geriatr Med. 2018 Nov;4:2333721418808146. https://doi.org/https://doi.org.10.1177/2333721418808146 DOI: https://doi.org/10.1177/2333721418808146
  53. Bachmann S, Finger C, Huss A, Egger M, Stuck AE, Clough-Gorr KM. Inpatient rehabilitation specifically designed for geriatric patients: systematic review and meta-analysis of randomised controlled trials. BMJ. 2010;340(apr20 2):c1718-c1718. https://doi.org/https://doi.org.10.1136/bmj.c1718 DOI: https://doi.org/10.1136/bmj.c1718
  54. Teodoro CR, Breault K, Garvey C, Klick C, O’Brien J, Purdue T, et al. STEP-UP: Study of the Effectiveness of a Patient Ambulation Protocol. Medsurg Nurs. 2016 Mar-Apr;25(2):111–6.
  55. Hamilton AC, Lee N, Stilphen M, Hu B, Schramm S, Frost F, et al. Increasing Mobility via In-hospital Ambulation Protocol Delivered by Mobility Technicians: A Pilot Randomized Controlled Trial. J Hosp Med. 2019 May;14(5):272–7. https://doi.org/https://doi.org.10.12788/jhm.3153 DOI: https://doi.org/10.12788/jhm.3153
  56. Raymond MJ, Jeffs KJ, Winter A, Soh SE, Hunter P, Holland AE. The effects of a high-intensity functional exercise group on clinical outcomes in hospitalised older adults: an assessor-blinded, randomised-controlled trial. Age Ageing. 2017 Mar;46(2):208–13. https://doi.org/https://doi.org.10.1093/ageing/afw215 DOI: https://doi.org/10.1093/ageing/afw215
  57. Fisher SR, Graham JE, Brown CJ, Galloway RV, Ottenbacher KJ, Allman RM, et al. Factors that differentiate level of ambulation in hospitalised older adults. Age Ageing. 2012 Jan;41(1):107–11. https://doi.org/https://doi.org.10.1093/ageing/afr110 DOI: https://doi.org/10.1093/ageing/afr110
  58. Pain H, Gale CR, Watson C, Cox V, Cooper C, Sayer AA. Readiness of elders to use assistive devices to maintain their independence in the home. Age Ageing. 2007 Jul;36(4):465–7. https://doi.org/https://doi.org.10.1093/ageing/afm046 DOI: https://doi.org/10.1093/ageing/afm046
  59. Trøstrup J, Andersen H, Kam CA, Magnusson SP, Beyer N. Assessment of Mobility in Older People Hospitalized for Medical Illness Using the de Morton Mobility Index and Cumulated Ambulation Score-Validity and Minimal Clinical Important Difference. J Geriatr Phys Ther. 2019 Jul/Sep;42(3):153–60. https://doi.org/https://doi.org.10.1519/JPT.0000000000000170 DOI: https://doi.org/10.1519/JPT.0000000000000170

Most read articles by the same author(s)