Effects of a nursing care program on functional outcomes in older acute medical in-patients: protocol for a randomized controlled trial

Cecília Rodrigues, Denisa Mendonça, Maria Manuela Martins, Cecília Rodrigues, Denisa Mendonça, Maria Manuela Martins

Abstract

Background: Hospitalization often leads to long periods of bed rest and inactivity which is associated with an increase in length of hospital stay, loss of capacity for basic self-care and discharge into a nursing home.

Objective: This trial aims to verify if a nursing care program centered on basic self-care and predefined physical activity, improves functional outcomes in older hospitalized patients.

Methods: This is a 2-group randomized controlled trial with repeated measures: 182 older acute medical patients will be blindly randomly allocated to the control group (n = 91) or intervention group (n = 91). The intervention will consist of nursing care intervention centered on basic self-care that includes a twice daily walking training, plus privileging pre-established trips to the toilet by walking and all daytime meals seated, off the bed. The main outcome was changes in the number of independent activities of daily living from 2 weeks before admission (baseline) to discharge. Trial registration: ClinicalTrials.gov (Identifier NCT03106064).

Results: This intervention has the potential to change the outcomes of the older patient in the acute setting.

Conclusion: The loss of independence in self-care is determinant in future health care needs. If our hypothesis is correct and demonstrate that this nursing care program centered on basic self-care for older acute medical patients improves functional outcomes, a change in the paradigmatic organization of hospital care may be justifiable.

Keywords: activities of daily living; elderly; functional outcomes; nursing care program; self-care.

Conflict of interest statement

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. The authors declare no conflicts of interest.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of PBJ-Associação Porto Biomedical/Porto Biomedical Society. All rights reserved.

Figures

Figure 1
Figure 1
Flow diagram of the study protocol.

References

    1. Hoogerduijn JG, Grobbee DE, Schuurmans MJ. Prevention of functional decline in older hospitalized patients: nurses should play a key role in safe and adequate care. Int J Nurs Pract. 2014;20:106–113.
    1. Covinsky KE, Palmer RM, Fortinsky RH, et al. Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc. 2003;51:451–458.
    1. Fimognari FL, Pierantozzi A, De Alfieri W, et al. The severity of acute illness and functional trajectories in hospitalized older medical patients. J Gerontol A Biol Sci Med Sci. 2017;72:102–108.
    1. Condorhuaman-Alvarado PY, Menéndez-Colino R, Mauleón-Ladrero C, et al. Predictive factors of functional decline at hospital discharge in elderly patients hospitalised due to acute illness [in Spanish]. Rev Esp Geriatr Gerontol. 2017;52:253–256.
    1. Sager MA, Franke T, Inouye SK, et al. Functional outcomes of acute medical illness and hospitalization in older persons. Arch Intern Med. 1996;156:645–652.
    1. Wood W, Tschannen D, Trotsky A, et al. A mobility program for an inpatient acute care medical unit. Am J Nurs. 2014;114:34–40.
    1. Zisberg A, Shadmi E, Sinoff G, et al. Low mobility during hospitalization and functional decline in older adults. J Am Geriatr Soc. 2011;59:266–273.
    1. De Saint-Hubert M, Schoevaerdts D, Poulain G, et al. Risk factors predicting later functional decline in older hospitalized patients. Acta Clin Belg. 2009;64:187–194.
    1. Hirsch CH, Sommers L, Olsen A, et al. The natural history of functional morbidity in hospitalized older patients. J Am Geriatr Soc. 1990;38:1296–1303.
    1. McVey LJ, Becker PM, Saltz CC, et al. Effect of a geriatric consultation team on functional status of elderly hospitalized patients. A randomized, controlled clinical trial. Ann Intern Med. 1989;110:79–84.
    1. Creditor MC. Hazards of hospitalization of the elderly. Ann Intern Med. 1993;118:219–223.
    1. Kosse NM, Dutmer AL, Dasenbrock L, et al. Effectiveness and feasibility of early physical rehabilitation programs for geriatric hospitalized patients: a systematic review. BMC Geriatr. 2013;13:107.
    1. D’Onofrio A, Büla C, Rubli E, et al. Functional trajectories of older patients admitted to an acute care unit for elders. Int J Older People Nurs. 2018;13:
    1. Graf C. Functional decline in hospitalized older adults. Am J Nurs. 2006;106:58–67.
    1. De Morton NA, Keating JL, Jeffs K. Exercise for acutely hospitalised older medical patients. Cochrane Database Syst Rev. 2007;CD005955.
    1. Hastings SN, Sloane R, Morey MC, et al. Assisted early mobility for hospitalized older veterans: preliminary data from the STRIDE program. J Am Geriatr Soc. 2014;62:2180–2184.
    1. De Morton NA, Keating JL, Jeffs K. The effect of exercise on outcomes for older acute medical inpatients compared with control or alternative treatments: a systematic review of randomized controlled trials. Clin Rehabil. 2007;21:3–16.
    1. Baztan JJ, Suárez-García FM, López-Arrieta J, et al. Effectiveness of acute geriatric units on functional decline, living at home, and case fatality among older patients admitted to hospital for acute medical disorders: meta-analysis. BMJ. 2009;338:b50.
    1. Mudge AM, McRae P, Cruickshank M. Eat walk engage: an interdisciplinary collaborative model to improve care of hospitalized elders. Am J Med Qual. 2015;30:5–13.
    1. Buurman BM, Van Munster BC, Korevaar JC, et al. Variability in measuring (instrumental) activities of daily living functioning and functional decline in hospitalized older medical patients: a systematic review. J Clin Epidemiol. 2011;64:619–627.
    1. White DK, Wilson JC, Keysor JJ. Measures of adult general functional status: SF-36 Physical Functioning Subscale (PF-10), Health Assessment Questionnaire (HAQ), Modified Health Assessment Questionnaire (MHAQ), Katz Index of Independence in activities of daily living, Functional Independence Measure (FIM), and Osteoarthritis-Function-Computer Adaptive Test (OA-Function-CAT). Arthritis Care Res (Hoboken). 2011;63 suppl 11:S297–S307.
    1. Petronilho F. Autocuidado: Conceito Central da Enfermagem. 1st edFormasau, Portugal: 2012.
    1. Zelada MA, Salinas R, Baztan JJ. Reduction of functional deterioration during hospitalization in an acute geriatric unit. Arch Gerontol Geriatr. 2009;48:35–39.
    1. Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340:c332.
    1. Katz S, Ford AB, Moskowitz RW, et al. Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA. 1963;185:914–919.
    1. Malloch K, Meisel M. Patient classification systems: state of the science 2013. Nurse Leader. 2013;11:35–37.

Source: PubMed

3
Subskrybuj