Original article
Factors Associated With Older Patients' Engagement in Exercise After Hospital Discharge

Presented to the 4th Australian and New Zealand Falls Prevention Society, Conference, November 21–23, 2010, Dunedin, New Zealand.
https://doi.org/10.1016/j.apmr.2011.04.009Get rights and content

Abstract

Hill A-M, Hoffmann T, McPhail S, Beer C, Hill KD, Brauer SG, Haines TP. Factors associated with older patients' engagement in exercise after hospital discharge.

Objectives

To identify factors that are associated with older patients' engagement in exercise in the 6 months after hospital discharge.

Design

A prospective observational study using qualitative and quantitative evaluation.

Setting

Follow-up of hospital patients in their home setting after discharge from a metropolitan general hospital.

Participants

Participants (N=343) were older patients (mean age ± SD, 79.4±8.5y) discharged from medical, surgical, and rehabilitation wards and followed up for 6 months after discharge.

Interventions

Not applicable.

Main Outcome Measures

Self-perceived awareness and risk of falls measured at discharge with a survey that addressed elements of the Health Belief Model. Engagement and self-reported barriers to engagement in exercise measured at 6 months after discharge using a telephone survey.

Results

Six months after discharge, 305 participants remained in the study, of whom 109 (35.7%) were engaging in a structured exercise program. Multivariable logistic regression analysis demonstrated participants were more likely to be engaging in exercise if they perceived they were at risk of serious injury from a fall (odds ratio [OR] =.61; 95% confidence interval [CI], .48–.78; P<.001), if exercise was recommended by the hospital physiotherapist (OR=1.93; 95% CI, 1.03–3.59; P=.04), and if they lived with a partner (OR=1.97; 95% CI, 1.18–3.28; P=.009). Barriers to exercise identified by 168 participants (55%) included low self-efficacy, low motivation, medical problems such as pain, and impediments to program delivery.

Conclusions

Older patients have low levels of engagement in exercise after hospital discharge. Researchers should design exercise programs that address identified barriers and facilitators, and provide education to enhance motivation and self-efficacy to exercise in this population.

Section snippets

Design

A prospective observational study using quantitative and qualitative evaluation was undertaken through 2 cross-sectional survey waves (at hospital discharge and 6 months after discharge).

Participants and Setting

Participants (N=343) were a cohort of consecutively enrolled patients who were discharged from general medical, surgical, stroke, or rehabilitation wards of 1 hospital. Participants were part of a multisite RCT (n=1206) that investigated the effect of an education intervention on fall rates in the hospital.30

Results

There were 350 participants enrolled in the RCT at the study site. Of these 350, 6 participants died and 1 withdrew in the hospital, leaving 343 participants in the discharge cohort. Participants' characteristics are presented in table 3. There were 90 participants (26.2%) who were classified as having cognitive impairment based on scoring less than 8 out of 10 on the SPMSQ.33 The research assistants interviewed 333 (97.1%) of the participants at discharge to administer the survey. Ten

Discussion

This study identified that older patients have low levels of engagement in exercise after discharge and that self-perceived risk of injury from a fall and other social and emotional factors affect engagement in exercise. Older patients also experienced numerous barriers to engaging in exercise after discharge. The most frequently reported barriers included low self-efficacy, such as a belief that exercise was not necessary, and medical barriers, such as experiencing pain on engaging in exercise.

Conclusions

Older patients have low levels of engagement in exercise after discharge, although they are at increased risk of functional decline and falls during this period.1, 6 This study identified barriers and facilitators to engagement in exercise during this period that can be used by researchers and clinicians to develop and evaluate suitable education and exercise interventions for this population. Health care workers who treat older patients in the postdischarge period should highlight fall risk,

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    Supported by the National Health and Medical Research Council (Australia) (project grant no. 456097); a Menzies Foundation PhD Fellowship; and a National Health and Medical Research Council Career Development Award.

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

    Reprints are not available from the authors.

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