Age-Friendly Care and Mobility in Hospitalized Older Adults With Cognitive Impairment: A Feasibility Quality Improvement Initiative.

BACKGROUND

Hospitalized older adults with cognitive impairment (CI) have an increased risk for adverse outcomes. Acute Care for Elders (ACE) Units were developed to reduce functional decline in hospitalized older adults.

INTERVENTION: We developed a quality improvement (QI) initiative to disseminate ACE care processes to non-ACE units, converting them into "Virtual ACE" units. The aim of this evaluation is to examine the impact of this intervention on the mobilization of patients with CI.

POPULATION: Older adults with CI admitted to a study unit (ACE Unit or seven Virtual ACE units).

METHODS

We conducted a pre/post-intervention evaluation of the proportion of informed respondents answering "yes" to the Acute Care Mobility Assessment (ACMA) interview item: "In the past 24 hours did the patient move from the bed to the chair, walk in the room, walk in the hallway?"

RESULTS

There were no significant differences in patient demographics, baseline activities of daily living (ADL) performance, history of falls, or consults to physical or occupational therapy between the total pre- (n = 56) versus post- (n = 135) intervention cohorts. The ACE Unit patients were significantly older (82.9 ± 7.5 vs. 75.5 ± 7.7 years, p < 0.05) and significantly more impaired in baseline ADL performance based on Katz Index scores (6.4 ± 4.4 vs. 8.5 ± 4.4, p < 0.05) compared to patients on Virtual ACE units. The proportion of patients with CI reported on ACMA interview to have mobilized from bed to chair (29% vs. 51%, p < 0.05) and ambulated into the hallway (13% vs. 27%, p < 0.05) in the prior 24 hours significantly increased post-intervention. Similar benefits were seen in the ACE and Virtual ACE patients evaluated separately.

CONCLUSION

This QI intervention demonstrated that disseminating ACE care processes to non-ACE units was associated with increased mobilization of hospitalized older adults with CI. Studies with larger sample sizes are needed to confirm findings.