AGS: Hospitals Curtail Mobility for Older Patients

SEATTLE, May 7 -- Hospitalized older patients spend too long flat on their back, a situation prompted at least in part by a hospital culture that discourages mobility, researchers said here.

Patients 65 and older at a VA hospital averaged only 18 minutes standing or walking over six hours, found Cynthia J. Brown, M.D., of the VA Medical Center and University of Alabama at Birmingham, and colleagues.

In the study, less than 25% of patients' time was spent sitting, standing or walking, they reported at the American Geriatric Society meeting.

"Geriatricians have long recognized that patients don't get up as much as they should in the hospital," Dr. Brown said. "But, this is the first time that it's actually been quantified."

The study included 30 male veterans 65 and older who were admitted to the general medical wards of the Birmingham VA.

Patients wore wireless motion monitors the size of a quarter on thigh and ankle that measured horizontal and vertical orientation of the patient every 20 seconds.

Motion was monitored for seven days after the first hospitalization day or until discharge (average length of stay 4.9 days).

One of the patients was under orders for bed rest (3%); and 37% received physical therapy.

Patients spent more than 75% of their hospital stay lying in bed.

The proportion of time patients spent sitting, standing or walking per six-hour period typically peaked around noon. It increased over the hospital stay as patients, presumably, got better (17% on day two, 19% on day three, and 21% on day four).

Less than 5% of their time was spent standing or walking.

"While you might argue that they spend little of their time at home walking -- the whole couch potato idea -- they're definitely not in bed 75% of their time," Dr. Brown said.

Inactivity over even a relatively short hospital stay may have an impact on older patients, she cautioned.

"People often think that if they're not there that long it doesn't matter, but that's not true for the geriatric population," Dr. Brown said.

Older patients may lose 1% to 5% of their muscle mass every 24 hours of bed rest and can become orthostatic within 24 to 48 hours.

The findings suggest physicians need to be more vigilant about getting patients up out of bed, said Eric J. Hardt, M.D., of Boston University, who commented on the study.

"This challenges us to find ways to keep people up and walking while they are sick in the hospital," he said.

More than just early physical therapy will be needed to accomplish this task, he said.

It may require extensive changes to hospital culture and environmental design, Dr. Brown said.

"This is just the tip of the iceberg," she said. "The whole hospital environment is focused on the bed."

For example, hospital rooms typically have only one chair leaving patients confined to their bed if a visitor comes. Also, the television is aimed at the bed and typically impossible for patients to tilt toward the chair.

Even if patients get up, they often have nowhere to go, Dr. Brown noted.

Furthermore, "patients have the idea that they're there to rest and it's easier to care for them while they're in bed," she added.