UCSF

PATEINT, NURSE, AND HOSPITAL FACTORS THAT INFLUENCE THE MOBILITY OF HOSPITALIZED OLDER ADULTS

Carla Graf

ABSTRACT

Older adults are commonly admitted to the hospital with medical illnesses. Unfortunately, suffering a decline in function, specifically the ability to walk, groom, or dress can be compromised as a result of the illness, the physiological changes related to aging, and hospital processes of care, especially omitting ambulation or other mobilizing activities. The purpose of this study was to investigate the factors that influenced the mobilization or lack of mobilization of hospitalized older adults on two medical units. The specific aims were to: identify, describe, and analyze the factors within a hospital environment that may influence the mobilization of older patients; the knowledge of nurses and physicians about the consequences of low mobility and the risk of loss of function for hospitalized older patients; and the perspectives of nurses and physicians about the factors that influenced their ability to provide adequate ambulation and mobilization of hospitalized older medical patients. Qualitative methodology, specifically in-depth interviews of nurses and physicians and participant observation was used to conduct the study. Data were collected with twelve registered nurses and physicians who frequently cared for older medicine patients in the acute care environment. Additionally, fifty hours of participant observation was conducted on the units across shifts and days of the week. Study results included both barriers and facilitators to patient mobilization, including patient factors such as acuity of illness, clinical stability or instability, presence of symptoms, and motivation; nurse factors such as time constraints and competing demands; and hospital factors such as the physical environment and lack of discipline accountability for mobilization activities. Barriers to mobilization outweighed the facilitators. These findings suggest a need for new ways of prioritizing older adults' need for mobilizing to prevent functional decline. Hospitalization can be the period where functional gains can be attained for many patients; however individual clinicians, hospitals, health care systems and payers must make this a priority.