Abstract
Objective
Hospitalization-associated disability [HAD, ie, the loss of ability to perform ≥1
basic activities of daily living (ADLs) independently at discharge] is a frequent
condition among older patients. The present study assessed whether a simple inpatient
exercise program decreases HAD incidence in acutely hospitalized very old patients.
Design
In this randomized controlled trial (Activity in Geriatric Acute Care) participants
were assigned to a control or intervention group and were assessed at baseline, admission,
discharge, and 3 months thereafter.
Setting and Participants
In total, 268 patients (mean age 88 years, range 75–102) admitted to an acute care
for older patients unit of a public hospital were randomized to a control (n = 125)
or intervention (exercise) group (n = 143).
Methods
Both groups received usual care, and patients in the intervention group also performed
simple supervised exercises (walking and rising from a chair, for a total duration
of ∼20 minutes/day). We measured ADL function (Katz index) and incident HAD at discharge
and after 3 months (primary outcome) and Short Physical Performance Battery, ambulatory
capacity, number of falls, rehospitalization, and death during a 3-month follow-up
(secondary outcomes).
Results
Median duration of hospitalization was 7 days (interquartile range 4 days). The intervention
group had a lower risk of HAD with reference to both baseline [odds ratio (OR) 0.36;
95% confidence interval (CI) 0.17–0.76, P = .007] and admission (OR 0.29; 95% CI 0.10–0.89, P = .030). A trend toward an improved ADL function at discharge vs admission was found
in the intervention group compared with controls (OR 0.32; 95% CI ‒0.04 to 0.68; P = .083). No between-group differences were noted for the other endpoints (all P > .05).
Conclusion and Implications
A simple inpatient exercise program decreases risk of HAD in acutely hospitalized,
very old patients.
Keywords
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Article info
Publication history
Published online: January 20, 2020
Footnotes
This study was supported by the Instituto de Salud Carlos III (Ministerio de Ciencia, Innovación y Universidades, Spain) (RD12/0043/0025, PI12/02852, PI15/00558 and PI18/00139); Biomedical Research Networking Center on Frailty and Healthy Aging (CIBERFES, Spain); and FEDER funds from the European Union. The work of Pedro L. Valenzuela is supported by a contract granted by the University of Alcalá (FPI2016).
The authors declare no conflicts of interest.
Trial registration: NCT0137489 (https://clinicaltrials.gov/ct2/show/NCT01374893).
Identification
Copyright
© 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
