The use of physical capacity measures to identify low mobility in acutely admitted older medical patients

PhD-project

Principal investigator: Ann Christine Bodilsen

Principal supervisor: Thomas Bandholm

Co-supervisors: Janne Petersen, Nina Beyer, and Ove Andersen.

Research initiative: Optimized Senior Patient Programme (OPTIMED), Clinical Research Centre, Copenhagen University Hospital, Hvidovre, and PMR-C.

Time frame: 2012-2015

Background: Acute medical illness and hospitalization of older persons are associated with an increased risk of permanent loss of muscle strength and independency. The functional consequences of losing muscle strength are greater in older compared to younger persons, because older persons possess less physical reserve capacity. Identifying older patients with low physical reserve capacity at admission is crucial in reducing some of the negative consequenses of hospitalization. Helth care providers have a need for valid and simple clinical measures of physical capacity that are able to identify older high-risk patients. Early, systematic identification may help identify frail older patients, who require special attention during hospitalization, and special post-discharge care, hereby linking the acute and community services more efficiently. Such better service-linking could potentially reduce some of the negative consequences of hospitalization, including loss of muscle strength, increased need for help to basic activities of daily living, institutionalization, and readmission.

Purpose: The purposes of the PhD-project are: 1) to investigate how acute hospitalization influences muscle strength and functional performance in older medical patients, and 2) to investigate the predictive ability of clinical measures of physical capacity to identify older high risk patients at hospital admittance. It is the hypotheses that older medical patients loose muscle strength and functional performance during their hospitalization, and that clinical measures of physical capacity can identify older high risk patients at hospital admittance.

Experimental approach: In project 1, medical patients aged ³ 65 years are included within 48 hours after admission. Isometric knee-extension strength, handgrip strength and functional performance are assessed at admission, at discharge, and 30-day after discharge. Twenty-four-hour mobility is measured during hospitalization whit the use of accelerometers.

In project 2, medical patients aged ³ 65 years are included. The study uses an inter-tester intra-day design. Patients are tested at two sessions in the acute medical unit within 24 hours of admission. The inter-tester reliability of four clinical measures of physical capacity; 4 meter walking speed, handgrip strength, 30-s chair stand test, and The Cumulated Ambulation Score will be determined

In project 3, medical patients aged ³ 65 years are included. Within 24 hours of admission, the patients are assessed with four clinical measures of physical capacity; 4 meter walking speed, handgrip strength, 30-s chair stand test, and The Cumulated Ambulation Score. The patients’ functional level at admission is evaluated using the de Morton Mobility Index and the Barthel Index. The patients are visited in their homes 30 days after discharge, and their functional level is reassessed. The ability of the four clinical measures in identifying older frail patients with low mobility following their hospitalization be determined.

Contact: Ann.Christine.Bodilsen@regionh.dk   Ann Christine Bodilsen


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