Older medical patients

Many acutely hospitalized patients are older medical patients, who are frail and have many comorbidities. They account for a great number of all hospital admissions and are frequently readmitted acutely. During their relatively short hospitalization they display low mobility, which is associated with several adverse outcomes, including reduced functional performance, compromised activities of daily living and a need for more personal assistance. Even short-term hospitalization may have a negative impact on muscle strength and functional performance that may be especially unfavorable in these older patients. That is, older persons generally possess less reserve-capacity in muscle strength and functional performance, compared to younger persons. Hence, loss of muscle strength and functional performance should be avoided in these patients.

The PMR-C research focus in older medical patients is to investigate the effectiveness of physical rehabilitation modalities to increase reserve-capacity in muscle strength and functional performance during and after acute hospitalization in older people. We systematically quantify levels of muscle strength and functional performance and potential deficits in relation to acute hospitalization – along with other key clinical symptoms – to gain a detailed understanding of these impairments, and to identify “at-risk patients”. We then explore the feasibility of early, impairment-directed physical rehabilitation modalities. The rehabilitation modalities are very simple, they are designed on the basis of identified deficits, and they use a basic exercise physiology rationale. If a rehabilitation modality seems feasible, that is, can be performed progressively with sufficient compliance, the effectiveness of the rehabilitation modality is finally investigated in a randomized controlled design.

All PMR-C research within older medical patients is conducted in close collaboration with the Optimized Senior Patient Programme (OPTIMED), Clinical Research Centre, Copenhagen University Hospital, Hvidovre.  

Selected papers
Bodilsen C, Pedersen MM, Petersen J, Beyer N, Andersen O, Lawson-Smith L, Kehlet H, Bandholm T (2013). Acute hospitalization of the old medical patient: changes in muscle strength and functional performance during hospitalization and 30 days after discharge. Am J Phys Med Rehabil 92: 789-796. 

Pedersen MM, Bodilsen AC, Petersen J, Beyer N, Andersen O, Lawson-Smith L, Kehlet H, Bandholm T (2013). Twenty-four-hour mobility during acute hospitalization in older medical patients. J Gerontol A Biol Sci Med Sci 68: 331-337.

Klausen HH, Petersen J, Lindhardt T, Bandholm T, Hendriksen C, Kehlet H, Vestbo J, Andersen O (2012). Outcomes in elderly Danish citizens admitted with community-acquired pneumonia. Regional differencties, in a public healthcare system. Respir Med 106: 1778-1787.

Ongoing research

Epidemiological strategies for adapting Disease Management Programs to older persons with multimorbidity

Rehabilitation of older medical patients: the role of progressive strength training

The use of physical capacity measures to identify functional disability in acutely admitted old medical patients

 


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