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June 3, 2013

Getting patients out of bed

Daily Briefing

Writing in the New York Times' "The New Old Age," Paula Span highlights the importance of mobility in hospital patients, noting that the average elderly patient spends less than an hour per day on his or her feet.

Being stuck in bed can impact mobility for two years

According to a 2009 study, hospitalized patients in their 70s spend 83% of their time in bed, despite being able to walk two weeks prior to being admitted. Overall, they spend an average of 43 minutes per day standing or walking, more than five hours less than healthy seniors spend on their feet while they're at home.

Span notes that a just a couple days spent immobile on bed rest can cause loss of strength and muscle mass, while simultaneously increasing the patient's risk of blood clots, bed sores, and pneumonia.

Cynthia Brown—the 2009 study's author and a geriatrician at the University of Alabama in Birmingham—has been sounding the alarm against prolonged immobility for decades.

Often, the consequence of seniors' hospitalization is a decline in what Brown calls "life-space mobility," a scale gauging how often patients leave their bed and move around the community. Patients in their 70s who undergo surgery show sharp declines in mobility, but they recover fairly quickly. However, patients hospitalized for medical reasons do not regain their mobility even two years later, she says.

How to improve patients' mobility

In Brown's latest study, which involved 100 patients at the VA Medical Center in Birmingham, Ala., researchers found that elderly patients maintained their mobility one month after surgery if they received twice-daily visits from staff members who helped them get out of bed. By contrast, individuals who were visited by staff for simple conversation suffered a significant decline in their life-space mobility score, Brown found.

According to Span, elderly patients are often scared to leave their hospital bed without ringing for help for fear of falling. Hospital staff and administrators also fear injuries because Medicare does not reimburse for additional costs from falls, including surgery. Moreover, overworked hospital staff may not have time to assist elderly patients during walks.

Brown calls on families—with staff permission—to be "cheerleaders" that help keep loves ones mobile after surgery. "[I]t can make a huge difference in the health of an older person," she says, adding, "We want people to say, 'We need Mama to get up'" (Span, "The New Old Age," New York Times, 5/30).

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