Potential Efficacy of Pragmatic Exercise Program (SPRINT) during Hospitalization in Older Adults on Health Care and Physical Performance: A Pilot Study.
Peyrusqué, E; Buckinx, Fanny; Bolduc, Aet al.
2021 • In Journal of Nutrition, Health and Aging, 25 (1), p. 126-133
Frailty; aging; geriatric; health system; hospital; mobility; physical activity; Age Factors; Aged; Exercise Therapy/methods; Female; Geriatric Assessment/methods; Hospitalization; Humans; Male; Pilot Projects; Prospective Studies; Physical Functional Performance; Exercise Therapy; Geriatric Assessment; Medicine (miscellaneous); Nutrition and Dietetics; Geriatrics and Gerontology
Abstract :
[en] OBJECTIVES: Immobilization contribute to iatrogenic decline in hospitalized older adult. Implementing physical activity (PA) seems to be one of the best and easy solution. However, PA interventions are poorly integrated into usual care and those available are either non-specific, need supervision or requested human/material resources. Thus, we aimed to assess the effect of a pragmatic, unsupervised, and specific PA program (SPRINT) on health care practice and functional capacities in hospitalized older patients.
DESIGN: Single arm interventional pragmatic pilot study.
SETTING: Geriatric Assessment Unit (GAU).
PARTICIPANTS: Of the 39 patients (> 65 years) hospitalized in a GAU and eligible, 19 agreed to participate (AP) and 20 declined (N-AP).
INTERVENTION: One of the 4 PA programs, developed by our team, was allocated according to mobility profile. Individual functional capacities (i.e. balance, walking speed, functional mobility profile (PFMP)), active time (METS> 1.5: min), length of hospitalization (LOS), discharge orientation were assessed at admission and discharge of GAU.
RESULTS: Baseline characteristics of the 2 groups were comparable. At discharge, the AP group improved more on walking speed (0.57 ± 0.21 vs. 0.64 ± 0.19; p = 0.013), Berg balance scale (41.8 ± 13.7 vs. 45.1 ± 9.7; p = 0.017) and PFMP (54.0 ± 7.1 vs 55.1 ± 5.5; p = 0.042) than the N-AP group. The LOS was significantly shorter in AP group compared to the N-AP group (5 vs. 36 days; p = 0.026) and more subjects in the AP group were oriented at home without health or social services (89.5 vs. 60%; p=0.065).
CONCLUSION: SPRINT appears effective to counteract iatrogenic decline and decreased the LOS. Moreover, this simple pragmatic PA tool seems to improve the life trajectory and healthcare practice in aging population. Further researches are needed to confirm these promising pragmatic results.
Disciplines :
Geriatrics
Author, co-author :
Peyrusqué, E ✱; Mylène Aubertin-Leheudre, PhD, Département des Sciences de l'Activité Physique, Université du Québec à Montréal (UQAM), Pavillon des sciences biologiques (SB), 4th floor, 141 avenue Président-Kennedy, SB-4615, Montreal, Quebec, Canada H3C 3P8, E-mail address: aubertin-leheudre.mylene@uqam.ca
Buckinx, Fanny ✱; Université de Liège - ULiège > Unité de recherche Santé publique, épidémiologie et économie de la santé (URSAPES) ; Centre de Recherche, Institut Universitaire de Gériatrie de Montréal (IUGM), CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, Canada ; Département des Sciences de l’Activité Physique, Faculté des Sciences, Université du Québec à Montréal, Montreal, Canada
Bolduc, A; Centre de Recherche, Institut Universitaire de Gériatrie de Montréal (IUGM), CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, Canada
Law, C; Centre de Recherche, Institut Universitaire de Gériatrie de Montréal (IUGM), CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, Canada
Kergoat, M-J; Département des Sciences de l’Activité Physique, Faculté des Sciences, Université du Québec à Montréal, Montreal, Canada ; Faculté de Médecine, Université de Montréal, Montreal, Canada
Aubertin-Leheudre, Mylène; Centre de Recherche, Institut Universitaire de Gériatrie de Montréal (IUGM), CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, Canada ; Département des Sciences de l’Activité Physique, Faculté des Sciences, Université du Québec à Montréal, Montreal, Canada ; Département des Sciences de l’Activité Physique, Université du Québec à Montréal (UQAM), Pavillon des sciences biologiques (SB), Montreal, Canada
✱ These authors have contributed equally to this work.
Language :
English
Title :
Potential Efficacy of Pragmatic Exercise Program (SPRINT) during Hospitalization in Older Adults on Health Care and Physical Performance: A Pilot Study.
The study was funded by the Comité Aviseur pour la Recherche Clinique [CAREC 2013 du Centre de Recherche de l’Institut Universitaire de Gériatrie de Montréal (CRIUGM)] and the Regroupement des Unités de courte durée gériatrique et des services hospitaliers de gériatrie du Québec (RUSHGQ), a nonprofit community of practice of Quebec geriatric assessment units coordinated by A. Bolducand chaired by Dr Marie-Jeanne Kergoat. M. Aubertin-Leheudre and F. Buckinx are supported by the Fonds de Recherche du Québec Santé (FRQS). F. Buckinx is also supported by the IRSC (Instituts de recherche en santé du Canada). The authors have no conflicts of interest to declare. Acknowledgment
Van Ancum JM, Scheerman K, Jonkman NH, et al. Change in muscle strength and muscle mass in older hospitalized patients: A systematic review and meta-analysis. Experimental gerontology. 2017;92: 34–41. DOI: 10.1016/j.exger.2017.03.006
Kortebein P, Ferrando A, Lombeida J, Wolfe R, Evans WJ. Effect of 10 days of bed rest on skeletal muscle in healthy older adults. Jama. 2007;297: 1772–1774. DOI: 10.1001/jama.297.16.1772-b
Mahoney J, Sager M, Dunham NC, Johnson J. Risk of falls after hospital discharge. Journal of the American Geriatrics Society. 1994;42: 269–274. DOI: 10.1111/j.1532-5415.1994.tb01750.x
Gill TM, Allore HG, Holford TR, Guo Z. Hospitalization, restricted activity, and the development of disability among older persons. Jama. 2004;292: 2115–2124. DOI: 10.1001/jama.292.17.2115
Sherrington C, Lord SR, Close JC, et al. A simple tool predicted probability of falling after aged care inpatient rehabilitation. Journal of clinical epidemiology. 2011;64: 779–786. DOI: 10.1016/j.jclinepi.2010.09.015
Buurman BM, Hoogerduijn JG, de Haan RJ, et al. Geriatric conditions in acutely hospitalized older patients: prevalence and one-year survival and functional decline. PloS one. 2011;6: e26951. DOI: 10.1371/journal.pone.0026951
Brown CJ, Redden DT, Flood KL, Allman RM. The underrecognized epidemic of low mobility during hospitalization of older adults. Journal of the American Geriatrics Society. 2009;57: 1660–1665.
Pedersen MM, Bodilsen AC, Petersen J, et al. Twenty-four-hour mobility during acute hospitalization in older medical patients. The journals of gerontology Series A, Biological sciences and medical sciences. 2013;68: 331–337.
Scheerman K, Raaijmakers K, Otten RHJ, Meskers CGM, Maier AB. Effect of physical interventions on physical performance and physical activity in older patients during hospitalization: a systematic review. BMC geriatrics. 2018;18: 288. DOI: 10.1186/s12877-018-0965-2
Cortes OL, Delgado S, Esparza M. Systematic review and meta-analysis of experimental studies: In-hospital mobilization for patients admitted for medical treatment. Journal of advanced nursing. 2019;75: 1823–1837. DOI: 10.1111/jan.13958
Martinez-Velilla N, Casas-Herrero A, Zambom-Ferraresi F, et al. Effect of Exercise Intervention on Functional Decline in Very Elderly Patients During Acute Hospitalization: A Randomized Clinical Trial. JAMA internal medicine. 2019;179: 28–36. DOI: 10.1001/jamainternmed.2018.4869
Saez de Asteasu ML, Martinez-Velilla N, Zambom-Ferraresi F, et al. Changes in muscle power after usual care or early structured exercise intervention in acutely hospitalized older adults. Journal of cachexia, sarcopenia and muscle. 2020.
Masse M, Meire P. [Is ageism a relevant concept for health care practice in the elderly?]. Geriatrie et psychologie neuropsychiatrie du vieillissement. 2012;10: 333–341. DOI: 10.1684/pnv.2012.0364
Deer RR, Dickinson JM, Fisher SR, Ju H, Volpi E. Identifying effective and feasible interventions to accelerate functional recovery from hospitalization in older adults: A randomized controlled pilot trial. Contemporary clinical trials. 2016;49: 6–14. DOI: 10.1016/j.cct.2016.05.001
Davis JC, Robertson MC, Ashe MC, Liu-Ambrose T, Khan KM, Marra CA. Does a home-based strength and balance programme in people aged > or =80 years provide the best value for money to prevent falls? A systematic review of economic evaluations of falls prevention interventions. British journal of sports medicine. 2010;44: 80–89. DOI: 10.1136/bjsm.2008.060988
Balzer K, Bremer M, Schramm S, Luhmann D, Raspe H. Falls prevention for the elderly. GMS health technology assessment. 2012;8: Doc01.
Farag I, Howard K, Hayes AJ, et al. Cost-effectiveness of a Home-Exercise Program Among Older People After Hospitalization. Journal of the American Medical Directors Association. 2015;16: 490–496. DOI: 10.1016/j.jamda.2015.01.075
Juneau A, Bolduc A, Nguyen P, et al. Feasibility of Implementing an Exercise Program in a Geriatric Assessment Unit: the SPRINT Program. Canadian geriatrics journal: CGJ. 2018;21: 284–289. DOI: 10.5770/cgj.21.311
Salvi F, Miller MD, Grilli A, et al. A manual of guidelines to score the modified cumulative illness rating scale and its validation in acute hospitalized elderly patients. Journal of the American Geriatrics Society. 2008;56: 1926–1931. DOI: 10.1111/j.1532-5415.2008.01935.x
Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of psychiatric research. 1975;12: 189–198. DOI: 10.1016/0022-3956(75)90026-6
Hebert R, Carrier R, Bilodeau A. The Functional Autonomy Measurement System (SMAF): description and validation of an instrument for the measurement of handicaps. Age and ageing. 1988;17: 293–302. DOI: 10.1093/ageing/17.5.293
Berg KO, Wood-Dauphinee SL, Williams JI, Maki B. Measuring balance in the elderly: validation of an instrument. Canadian journal of public health = Revue canadienne de sante publique. 1992;83 Suppl 2: S7–11.
Laferrière L BL, Narezny M, Ryan M, Tibi G, Chardon JW. Reliability and the validity of the physiotherapy functional mobility profile questionnaire. 17. 2001;217–28.
Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society. 1991;39: 142–148. DOI: 10.1111/j.1532-5415.1991.tb01616.x
Bohannon RW. Reference values for the timed up and go test: a descriptive meta-analysis. Journal of geriatric physical therapy (2001). 2006;29: 64–68. DOI: 10.1519/00139143-200608000-00004
Welk GJ, McClain JJ, Eisenmann JC, Wickel EE. Field validation of the MTI Actigraph and BodyMedia armband monitor using the IDEEA monitor. Obesity (Silver Spring, Md). 2007;15: 918–928. DOI: 10.1038/oby.2007.624
van Stralen MM, Lechner L, Mudde AN, de Vries H, Bolman C. Determinants of awareness, initiation and maintenance of physical activity among the over-fifties: a Delphi study. Health education research. 2010;25: 233–247. DOI: 10.1093/her/cyn045
Lockenhoff CE, Carstensen LL. Socioemotional selectivity theory, aging, and health: the increasingly delicate balance between regulating emotions and making tough choices. Journal of personality. 2004;72: 1395–1424. DOI: 10.1111/j.1467-6494.2004.00301.x
McPhee JS, French DP, Jackson D, Nazroo J, Pendleton N, Degens H. Physical activity in older age: perspectives for healthy ageing and frailty. Biogerontology. 2016;17: 567–580. DOI: 10.1007/s10522-016-9641-0
Devereux-Fitzgerald A, Powell R, Dewhurst A, French DP. The acceptability of physical activity interventions to older adults: A systematic review and meta-synthesis. Social science & medicine (1982). 2016;158: 14–23. DOI: 10.1016/j.socscimed.2016.04.006
Peiris CL, Taylor NF, Shields N. Extra physical therapy reduces patient length of stay and improves functional outcomes and quality of life in people with acute or subacute conditions: a systematic review. Archives of physical medicine and rehabilitation. 2011;92: 1490–1500. DOI: 10.1016/j.apmr.2011.04.005
Rashidi B, Kobewka DM, Campbell DJT, Forster AJ, Ronksley PE. Clinical factors contributing to high cost hospitalizations in a Canadian tertiary care centre. BMC health services research. 2017;17: 777. DOI: 10.1186/s12913-017-2746-6
Stadnyk RL. Three policy issues in deciding the cost of nursing home care: provincial differences and how they influence elderly couples’ experiences. Healthcare policy = Politiques de sante. 2009;5: e132–144. DOI: 10.12927/hcpol.2009.20936
Olsen C, Pedersen I, Bergland A, et al. Differences in quality of life in home-dwelling persons and nursing home residents with dementia — a cross-sectional study. BMC geriatrics. 2016;16: 137. DOI: 10.1186/s12877-016-0312-4
Simeao S, Martins GAL, Gatti MAN, Conti MHS, Vitta A, Marta SN. Comparative study of quality of life of elderly nursing home residents and those attneding a day Center. Ciencia & saude coletiva. 2018;23: 3923–3934. DOI: 10.1590/1413-812320182311.21742016
Falvey JR, Burke RE, Malone D, Ridgeway KJ, McManus BM, Stevens-Lapsley JE. Role of Physical Therapists in Reducing Hospital Readmissions: Optimizing Outcomes for Older Adults During Care Transitions From Hospital to Community. Physical therapy. 2016;96: 1125–1134. DOI: 10.2522/ptj.20150526
Billett MC, Campanharo CRV, Lopes M, Batista REA, Belasco AGS, Okuno MFP. Functional capacity and quality of life of hospitalized octogenarians. Revista brasileira de enfermagem. 2019;72: 43–48. DOI: 10.1590/0034-7167-2017-0781
