Juliessa Pavon, MD, MHS1, Richard Sloane, MPH2, Carl Pieper, Dr.Ph2, Cathleen Colon-Emeric, MD, MHS2, David Gallagher, MD2, Harvey Cohen, MD2, Katherine Hall, Ph.D., Miriam Morey, Ph.D., Midori McCarty, Susan Hastings, MD, MHS2, 1Duke University, Durham, NC; 2Durham, NC

Meeting: Hospital Medicine 2019, March 24-27, National Harbor, Md.

Abstract number: 107

Categories: Geriatrics, Hospital Medicine 2019, Research

Keywords: , , ,

Background: Hospital-acquired disability (HAD) is common, and a key contributor to this process is low hospital physical activity. This study examines whether objective measures of hospital physical activity from wearable accelerometers can be used to predict HAD.

Methods: Prospective observational study of community-dwelling older adults aged ≥ 60 years, admitted to an academic hospital’s general medicine service from January 2016-March 2017, and enrolled within 24 hours of admission. Hospital activity was measured using ankle-mounted accelerometers from admission until discharge (or ≤ 7 days). Primary outcome was HAD, determined by self-reported ability to perform 1) Katz’s activities of daily living (ADL), (score range 0-5), and 2) broader functional activities using the Late-Life Functional and Disability instrument (FDI) (score range 15-75). HAD was defined as having one or more new ADL deficits, decline of 4 or greater on the Late-Life FDI, calculated between baseline and discharge, or discharge to skilled nursing facility (SNF). Relationships between hospital physical activity measures (mean active time (hrs/day); mean sedentary time (awake but not moving, hrs/day); mean step counts per day; and a 900 steps/day threshold) and HAD were examined with bivariate and logistic regression analyses.

Results: We approached 210 eligible patients and 79 enrolled. Patients were excluded due to incomplete accelerometer data (n=14), or missing discharge functional data (n=17). Among 48 patients with complete data, mean age was 73.2 years (SD 9.5), 48% were male, 77% were Caucasian. Median length of stay was 4 days (IQR 2.0, 6.0)); 62% (n=40) reported being able to walk without assistance at baseline. HAD rate was 42% (n=20); 25% (n=12) had a self-reported decline in function and 17% (n=8) were discharged to SNF. Those with HAD had lower activity time (0.9 hrs/day vs. 1.6 hrs/day, p=0.02), and lower step counts (1402 steps/day vs. 2235 steps/day, p=0.04), but no difference in sedentary time, compared to those without HAD. Overall, 25% (n=12) walked < 900 steps/day, of these, 67% (n=8) developed HAD, representing a 2 fold increased risk of developing HAD (RR 2.0, 1.1-3.7).

Conclusions: Accelerometer-based measures of hospital physical activities are associated with a clinically meaningful patient outcome; hospital acquired disability. Clinicians could use wearable technology in mobility enhancement interventions to appropriately target physical /occupational therapy or walking programs, monitor adherence to activity recommendations, and assess patient recovery.

To cite this abstract:

Pavon, JM; Sloane, R; Pieper, C; Colon-Emeric, C; Gallagher, D; Cohen, HJ; Hall, K; Morey, MC; McCarty, M; Hastings, SN. ACCELEROMETER MEASURED HOSPITAL ACTIVITY AND THE ASSOCIATION WITH HOSPITAL ACQUIRED DISABILITY IN OLDER ADULTS. Abstract published at Hospital Medicine 2019, March 24-27, National Harbor, Md. Abstract 107. Accessed January 25, 2020.

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