Factors Associated with Step Numbers in Acutely Hospitalized Older Adults: The Hospital-Activities of Daily Living Study
Daisy Kolk, Jesse J. Aarden, Janet L. MacNeil Vroomen, Lucienne A. Reichardt, Rosanne van Seben, Marike van der Schaaf, M. van der Esch, Jos W. R. Twisk, Jos A. Bosch, Bianca M. Buurman, Raoul Engelbert, Ingeborg M.J.A. Kuper, Annemarieke de Jonghe, Maike Leguit-Elberse, Ad Kamper, Nynke Posthuma, Nienke Brendel, Johan Wold
Abstract
OBJECTIVES: To determine the number of steps taken by older patients in hospital and 1 week after discharge; to identify factors associated with step numbers after discharge; and to examine the association between functional decline and step numbers after discharge. DESIGN: Prospective observational cohort study conducted in 2015-2017. SETTING AND PARTICIPANTS: Older adults (≥70 years of age) acutely hospitalized for at least 48 hours at internal, cardiology, or geriatric wards in 6 Dutch hospitals. METHODS: Steps were counted using the Fitbit Flex accelerometer during hospitalization and 1 week after discharge. Demographic, somatic, physical, and psychosocial factors were assessed during hospitalization. Functional decline was determined 1 month after discharge using the Katz activities of daily living index. RESULTS: The analytic sample included 188 participants [mean age (standard deviation) 79.1 (6.7)]. One month postdischarge, 33 out of 174 participants (19%) experienced functional decline. The median number of steps was 656 [interquartile range (IQR), 250-1146] at the last day of hospitalization. This increased to 1750 (IQR 675-4114) steps 1 day postdischarge, and to 1997 (IQR 938-4098) steps 7 days postdischarge. Age [β = -57.93; 95% confidence interval (CI) -111.15 to -4.71], physical performance (β = 224.95; 95% CI 117.79-332.11), and steps in hospital (β = 0.76; 95% CI 0.46-1.06) were associated with steps postdischarge. There was a significant association between step numbers after discharge and functional decline 1 month after discharge (β = -1400; 95% CI -2380 to -420; P = .005). CONCLUSIONS AND IMPLICATIONS: Among acutely hospitalized older adults, step numbers double 1 day postdischarge, indicating that their capacity is underutilized during hospitalization. Physical performance and physical activity during hospitalization are key to increasing the number of steps postdischarge. The number of steps 1 week after discharge is a promising indicator of functional decline 1 month after discharge.