A geriatric inpatient mobility-focused intervention improves function while requiring attention on its feasibility and sustainability

Background: Older adults often experience functional decline during hospitalisation. Adoption of early mobility interventions in acute care settings is paramount in mitigating such adverse effects.

Purpose: This study aimed to examine the effectiveness of mobility-focused intervention in improving independence in activities of daily living and mobility of older adults during hospitalisation, and to evaluate its implementation.

Methods: This was a quasi-experimental study where patients aged ≥75 years were assigned to either the intervention or control group. Both groups received usual clinical care. Using the 4Ms (Mobility, Mentation, Medication, What Matters) framework, the intervention group additionally received a comprehensive geriatric assessment, frequent mobilisation, and group-based programs (physiotherapy and art therapy) during hospitalisation. Modified Barthel Index (MBI), gait speed (GS) and maximum walking distance (MWD) of patients were measured upon hospital admission and discharge. Linear regression was used to examine the differences in clinical outcome change between groups. Semi-structured interviews were conducted with 18 implementers (healthcare professionals) to explore their experiences on the implementation. Interviews were transcribed and analysed inductively using thematic analysis.

Results: 76 patients (82.4±5.4years) were recruited. The intervention group (n=38) improved their MBI (β=4.19[0.60,7.79], p=0.023) and MWD (β=30.05[-0.23,60.33], p=0.052) compared to the control group (n=38). Both groups showed similar GS change (β=0.04[-0.02,0.10], p=0.209). Implementers’ narratives highlighted two themes a) enhanced patient care and professional autonomy; and b) competing duties and patients’ condition challenged implementation feasibility. Generally, the mobility intervention was acceptable to healthcare professionals but manpower constraint challenged the feasibility of implementation.

Conclusion: While the mobility-focused intervention showed promising results on MBI and possibly MWD of patients, manpower adaptation and improved buy-in from staff are needed to improve feasibility and sustainability of interventions.

Practical implications: Mobility-focused interventions can be safely implemented in the acute care settings to improve functional outcomes of older adults.

Funding: GERI Intramural Grant (GERI1627)