Elsevier

Geriatric Nursing

Volume 41, Issue 5, September–October 2020, Pages 608-614
Geriatric Nursing

Feature Article
Promotion of mobility among hospitalised older adults: An exploratory study on perceptions of patients, carers and nurses

https://doi.org/10.1016/j.gerinurse.2020.03.015Get rights and content

Highlights

  • Promoting mobility during hospitalisation can mitigate risks of elderly functional decline.

  • Perspectives of elderly patients and carers on activities in hospital need further exploration.

  • Main barriers and influencing factors deterring mobility in hospital need to be addressed.

  • Culturally appropriate strategies can be implemented to improve mobility in hospitalised elderly.

Abstract

Background

Hospitalisation of an older adult due to acute medical illness can result in adverse events and accelerate loss of independence despite recovery from the illness. Promoting mobility during hospitalisation can help to mitigate the risks of functional decline. Understanding the perspectives on the barriers and the maintenance of mobility is essential in the development of effective strategies.

Aims

To explore the perceptions of patients and their carers, as well as the nurses on promotion of mobility among hospitalised adult older patients.

Methods

A qualitative descriptive study design with purposive and convenience sampling approach was undertaken. A total of fourteen patients, six carers and ten nurses from a general medical ward of an acute care tertiary public hospital in Singapore were recruited over the period of November 2017 to February 2018. Face to face semi-structured interviews were conducted and audio-recorded. The interview transcripts were coded and an inductive content analysis approach was adopted to generate categories of sub-themes and themes through the open coding process.

Results

Four main themes were generated: (1) perceived and induced fear of falling; (2) challenges in initiation of mobility; (3) influence of premorbid status and physical condition on activity level; and (4) strategies to promote mobility.

Conclusion

Recognition of the importance of mobility as well as the detrimental effects of prolonged bed rest during hospitalization is an essential first step toward developing successful interventions to promote mobility in the Asian context. Improvements need to be made to help overcome the various barriers and challenges in the mobilization of the older patients in the acute care settings. Nurses and other members of the care team can help to increase the confidence of patients and among family carers (in providing assistance during mobility) by role modelling and provision of walking aids as well as risk-based education.

Section snippets

Summary statement of implications for practice

What does this research add to existing knowledge in gerontology?

  • Perspectives of elderly patients and their family carers regarding mobility in hospital need further exploration.

  • Barriers identified included: perceived and induced fear of falling, challenges in initiation of physical activity, influence of premorbid status and physical condition on activity level.

  • Strategies to promote mobility included: increased collaboration and involvement of health care team, educating and empowering

Background

Hospitalisation of an older adult due to acute medical illness can result in adverse events and accelerate loss of independence despite recovery from the illness.1,2 Deconditioning, which is a decrease in muscle mass and a cascade of physiological changes that occurs across the body systems, is a common adverse event for a hospitalised older adult. Deconditioning also results in functional decline, which is defined as a loss of independence in basic and instrumented activities of daily living

Demographic characteristics

A total of 30 participants including 14 older adult patients, 6 family carers and 10 nurses were recruited in this study. The age of the patients ranged from 69 years to 87 years and most were female (85.7%). The age of the family carers ranged from 39 to 61 and most were female (66.6%). Most of the nurses had more than 5 years of clinical experience (80%). Sociodemographic data of the patients, family carers and nurses are reported in Table 2. The duration of the participants’ interviews

Discussion

This study revealed various barriers, challenges and influencing factors in the promotion of mobility of older patients in the acute care settings. Fear of fall was a common barrier among the patients, carers and nurses. Some patients were worried about ambulating independently because of the risk of falling whereas others restricted their activities so as not to add on to the nurses’ workload, which was in agreement with other studies.19,24,38, 39, 40 Fear of fall occurred more frequently

Conclusion

Recognition of the importance of mobility during hospitalization as well as the detrimental effects of immobility is an essential first step toward developing successful interventions to promote mobility in the Asian context. Improvements need to be made to help overcome the various barriers and challenges in the mobilization of the older patients in the acute care settings. With increased encouragement and motivation provided by nurses, patients and family carers may be more confident to be

Declaration of Competing Interest

The authors have no conflict of interest to disclose.

Acknowledgments

We are grateful to the staff of involved wards for their support and assistance in completing this study. We would also like to thank Ms. Sylvia Liew for assisting with transcription of the data. We thank the participants in this study for sharing their valuable views.

Funding statement

This study is funded by Singapore General Hospital Research Grant, 2017.

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