People who are inactive during hospitalisation are at risk of ‘hospital associated functional decline’, also known as deconditioning. A range of problems can result, from a loss of independence to having an extended time away from and being unable to discharge home. Deconditioning is a leading complication of hospitalisation [1] and while it can affect people at any age, older adults are particularly vulnerable. In Australia alone, there are over 4 million acute hospitalisations where at least overnight care is required each year, with nearly half of patient bed days for people aged 65 years or older [2]. The impacts of inactivity are large and will not change without intervention. But the good news is, that the consequences of inactivity can be prevented and treated by moving more (physical activity) and sitting less (breaking up or reducing sedentary behaviour).
Thanks to a 2022 Strategic Innovation Program grant, my collaborators and I are making world-first evidence-based recommendations for older adults who are hospitalised with an acute medical illness, on using functional and self-care activities as opportunities to accumulate body-movement throughout the day. Evidence-based guidelines can have widespread impacts on clinical practice and people’s health behaviours. Yet there are no guidelines about what activity to do in hospital - patients want quality information about self-directed strategies to support their recovery [3].
For this project, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology is being used to conduct a systematic review and develop the guideline. A Guideline Development Panel and Consumer Advisory Group have been involved in all significant decision making. Key decisions have included to focus on creating a guideline for consumers (rather than for health care workers or hospitals/organisations) and to prioritise a particular intervention approach and associated outcomes.
In the acute hospital setting, activity interventions can take various forms, from specific exercises or rehabilitation-related activities, to mobility and functional maintenance programs or behaviour change interventions. The most important strategy our groups identified for the guideline focus, was to understand whether just doing small amounts of activity over the course of a day could help
- prevent a decline in function
- result in improved independence in activities of daily living
- improve confidence, knowledge or a sense of autonomy
- improve someone's mental or emotional outlook
- improve quality of life
- or, reduce the risk or occurrence of clinical deterioration events
The Panel and Consumer groups have furthermore played a vital role in: interpreting the review results in light of the significance of the problem of inactivity during hospitalisation, weighing up potential benefits and risks, assessing evidence quality, and addressing issues of feasibility, acceptability and resources that would be required to do this intervention in practice.
As the project nears completion, the Panel and Consumer groups are at the stage of refining the final recommendation wording. While the main results will be first shared at the AAG conference in November, the team are also working on getting the systematic review findings and the guideline/recommendation document published, along with a consumer handout that can be used at the bed-side by patients in medical wards of hospitals across Australia.
References:
[1] Loyd, C., et al., Prevalence of Hospital-Associated Disability in Older Adults: A Meta-analysis. J Am Med Dir Assoc, 2020. 21(4): p. 455-461.e5.
[2] Australian Institute of Health and Welfare, Hospital activity. 2023. Available at https://www.aihw.gov.au/reports-data/myhospitals/themes/hospital-activity
[3] Koenders, N., et al., Multifaceted interventions are required to improve physical activity behaviour in hospital care: a meta-ethnographic synthesis of qualitative research. J Physiother, 2021. 67(2): p. 115-123.