Low mobility during hospitalization and functional decline in older adults

Objectives: To examine the association between mobility levels of older hospitalized adults and functional outcomes.

Design: Prospective cohort study.

Setting: A 900-bed teaching hospital in Israel.

Participants: Five hundred twenty-five older (≥70) acute medical patients hospitalized for a nondisabling condition.

Measurements: In-hospital mobility was assessed using a previously validated scale. The main outcomes were decline from premorbid baseline functional status at discharge (activities of daily living (ADLs)) and at 1-month follow-up (ADLs and instrumental ADLs (IADLs)). Hospital mobility levels and functional outcomes were assessed according to prehospitalization functional trajectories. Logistic regressions were modeled for each outcome, controlling for functional status, morbidity, and demographic characteristics.

Results: Forty-six percent of participants had declined in ADLs at discharge and 49% at follow-up; 57% had declined in IADLs at follow-up. Mobility during hospitalization was twice as high in participants with no preadmission functional decline. Low versus high in-hospital mobility was associated with worse basic functional status at discharge (adjusted odds ratio (AOR)=18.03, 95% confidence interval (CI)=7.68-42.28) and at follow-up (AOR=4.72, 95% CI=1.98-11.28) and worse IADLs at follow-up (AOR=2.00, 95% CI=1.05-3.78). The association with poorer discharge functional outcomes was present in participants with preadmission functional decline (AOR for low vs high mobility=15.26, 95% CI=4.80-48.42) and in those who were functionally stable (AOR for low vs high mobility=10.12, 95% CI=2.28-44.92).

Conclusion: In-hospital mobility is an important modifiable factor related to functional decline in older adults in immediate and short-term (1-month follow-up) functional outcomes.