Physical Activity, Prevention of Functional Decline and Support of Mobility in Older Hospitalized Patients: A Literature Review

Purpose

Physical activity is the basis for participation and social life. Older hospitalized patients are prone to decline of physical activity and functional status. Mobilization and activation of older patients are mandatory in order to avoid loss of independence and admission to residential care. As first step of an own empirical study, this literature study aims to overview the current state of knowledge about mobility in older patients in acute hospitals. We reviewed papers on nurses’ knowledge, risk assessments, and interventions on prevention of functional decline and sustaining of mobility.

Methods

A systematic literature search in PubMed, CINAHL and Cochrane has been conducted using MeSH terms and keywords. All study designs were included. Publication period was limited to the last 35 years; English and German language papers were included. A hand search in three German nursing journals and citation tracking were conducted. A search for guidelines is ongoing. Data were charted and extracted with a standardized extraction sheet by one reviewer.

Results

The search revealed 211 studies after title screening. Duplicates were removed and 187 abstracts were screened. A total of 36 full-text articles were assessed for eligibility, and 15 articles were excluded. The remaining 21 papers reported about research conducted in the United States, Australia and four European countries. The qualitative studies (n=7) used a phenomenological approach or grounded theory dealing with changes in mobility in older patients, barriers in ambulation of patients reported by nurses, and assistance in ADLs and care dependency reported by patients and nurses. Observational studies (n=11) reported on risk assessments, preventive measures, and on frequency and duration of mobilizing. The RCT (n=1) included in this review dealt with promoting mobility. The reviews (n=2) outlined positive outcomes of promoting mobility through interdisciplinary interventions.

Conclusion

Our review revealed that little research has been conducted during the last decades in the field of mobility in older patients in acute hospitals. The identified papers and own experience suggest insufficient mobility offers and a lot of potential for improvement in order to enhance and preserve older patients’ mobility in the acute hospital environment. Therefore, in a next step, mobility patterns during nursing situations will be observed in two German acute hospitals. We aim to generate a better theoretical understanding and to explore the need for intervention development.