Older adults’ activity on a geriatric hospital unit: A behavioral mapping study

Abstract

Background: Systematic reviews highlight a preponderance of prolonged sedentary behavior in the hospital setting, with possible consequences for patients’ health and mobility. To date, most of the published literature in this field focus on the hospital experience for older adults with dementia or stroke. Few data describe hospital activity patterns in specialized geriatric units for frail older adults, who are already at risk of spending prolonged periods of time sitting. Yet, promoting older adults’ activity throughout hospitalization, when possible, is an avenue for exploration to identify opportunities to encourage more daily functional activities, and minimize the risk of post-hospital syndrome. Methods: This was a two-part observational study to describe (1) the hospital indoor environment and (2) patients’ activity patterns (using behavioral mapping) within public areas of two hospital units. One combined-trained physiotherapist and occupational therapist recorded information on indoor environmental features for two acute geriatric hospital units, such as potential opportunities for sitting and walking (i.e., handrails, chairs, benches, etc.), and identified obstacles which may impede activity (i.e., food or laundry carts in hallways, etc.). The observer also systematically scanned these units every 15 minutes (8 am to 4 pm) over two days/unit (one weekday and one weekend day) using standard behavioral mapping methods. There were three to four observation stations identified on each unit to count the number of people who were present, distinguish their role (patient, visitor), approximate age, gender, and body position or activity (sitting, standing, walking). We did not enter patients’ rooms. We described units’ indoor environment, and observed activity for each unit. We used Chi square tests to compare differences in observations between units, day of the week, and gender. Results: For both units there were similar indoor environmental features, with the exception of the floorplans, number of beds, minor differences in flooring materials, and an additional destination room (two lounges attached to one unit). Both units had items such as laundry carts against walls in hallways, blocking handrails, when present. We observed between 46–86% (average 60%) of admitted patients in the public areas of hospital units, with variability depending on unit and day: More than half of the observations were of patients sitting. Approximately 20% of patients were observed more than once: This included five women and seven men. There were significant associations for gender and observations on weekdays (men > women; Chi square = 17.01, p men; Chi square = 6.11, p = 0.013). There were more visitor observations on Unit 2. Conclusions: These exploratory findings are an opportunity to, generate hypotheses for future testing, and act as a starting point to collaborate with front line clinicians to highlight the indoor environment’s role in promoting activity, and develop future strategies to safely introduce more activity into the acute care setting for older adults.