Feature ArticlePromotion of mobility among hospitalised older adults: An exploratory study on perceptions of patients, carers and nurses
Section snippets
Summary statement of implications for practice
What does this research add to existing knowledge in gerontology?
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Perspectives of elderly patients and their family carers regarding mobility in hospital need further exploration.
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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.
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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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2021, Geriatric NursingCitation Excerpt :Therefore, if interventions aiming to prevent this functional decline through increased in-hospital mobility are to be implemented effectively, one must explore in depth, how older patients understand and experience mobility and physical activity during hospitalization, as well as enquire into the context of these experiences.15 On a personal as well as inter-personal level, studies have reported that patients abstain from increasing mobility during hospitalization for different reasons, such as: fear of falling or exacerbating illness;16–21 expectations of bed rest as a necessary part of hospitalization;20,22 poor physical status (e.g. symptoms and pain);16–18,21–26 and fear of bothering the staff or non-availability of walking aids.17,18,21,26,27 On an external level, studies show that in-hospital mobility is limited due to lack of meaningful activities and entertainment;27,28 nursing interventions and functional restraints (e.g. treatment regimens and catheters);21,25 lack of negotiation of goals or staff underestimating the abilities of the patient;16,23,26 lack of opportunities for physical activity in the hospital17,18,21,25 and hospital routines not facilitating mobility (e.g. lack of time).7,27,28
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