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Reversibility of nosocomial disability in hospitalized elderly patients through an individualized multicomponent exercise program: a randomized controlled trial

Authors:

Nicolas Martínez-Velilla ,

Department of Geriatrics. Complejo Hospitalario de Navarra, ES
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Alvaro Casas Herrero,

Department of Geriatrics. Complejo Hospitalario de Navarra, ES
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Fabricio Zambom Ferraresi,

Universidad Publica de Navarra, ES
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Mikel Lopez Saez de Asteasu,

Universidad Publica de Navarra, ES
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Marta Gutierrez Valencia,

Department of Geriatrics. Complejo Hospitalario de Navarra, ES
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Javier Alonso Renedo,

Department of Geriatrics. Complejo Hospitalario de Navarra, ES
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Belén González Glaría,

Department of Geriatrics. Complejo Hospitalario de Navarra, ES
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María Gonzalo Lazaro,

Department of Geriatrics. Complejo Hospitalario de Navarra, ES
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Agurne García Baztán,

Department of Geriatrics. Complejo Hospitalario de Navarra, ES
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Itziar Iráizoz Apezteguia,

Department of Geriatrics. Complejo Hospitalario de Navarra, ES
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Mikel Izquierdo Redin

Universidad Publica de Navarra, ES
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Abstract

Introduction: Acute hospital admissions are sentinel events that play an important role in the disabling process of older adults, determining short and long term disability, nursing home placement or mortality. Despite the resolution of the reason that caused the hospital admission, the patient can be discharged with a major new disability that was not present before the onset of the acute illness, and older adults who are frail are particularly vulnerable to this nosocomial disability.

Methods: This study was a a randomized clinical trial conducted in the Department of Geriatric. Hospitalized patients who met the inclusion criteria were randomly assigned within the first 48 h of admission. Participants  assigned to the usual care group received habitual hospital care, which included physical rehabilitation when needed. The intervention consisted of a multicomponent exercise training programme composed of supervised progressive resistance exercise training, balance-training, and walking for 5–7 consecutive days. During the training period, patients trained in 20 min sessions twice a day morning and evening. The primary outcome measure was the change in functional and cognitive status during the study period. The secondary outcome measure were,  the Spanish versión of the Quality of life EuroQol Scale, Delirium, mortality, use of health resources and falls

Results: A total of 157 patients in the intervention group and 153 patients in the usual care group finally entried the study. The analysis of the primary end point in the intention-to-treat population showed that the intervention improved function Barthel, SPPB, gait speed and cognition MMSE, Yesavage, as well as quality of life, with the same mean days of stay in the hospital. This results remained partially across the three months of follow up, but we did´n find differences in use of health resources or survival.

Discussion: This trial demonstrates that a multicomponent, individualized and progressive exercise programme provides effective therapy for improving function and cognition of older adults hospitalized for medical pathology, not only preventing usual nosocomial disability, but also revesing disability and frailty at least at shorterm. The study couldn´t find differences in the use of health resources because of the limitations of the follow of a very complex population with high degrees of disability.

Conclusion: A multicomponent exercise programme can prevent hospital associated disability and cognitive decline, and at least partially reverse frailty in older adults admitted to a hospital

Lessons learned: A change of the current system of hospitalization of older adults with medical conditions may be justified. While the current system does not promote the execution of a scheduled exercise routine during the hospitalization period, if we can modify the current guidelines, it is likely that patients will present lower levels of functional and cognitive impairment after the hospitalization period, experience a better quality of life.  

Suggestions for future research: It´s necessary to replicate these results in multicentric studies and assess the ability of the program during longer periods of time. 

How to Cite: Martínez-Velilla N, Casas Herrero A, Zambom Ferraresi F, Lopez Saez de Asteasu M, Gutierrez Valencia M, Alonso Renedo J, et al.. Reversibility of nosocomial disability in hospitalized elderly patients through an individualized multicomponent exercise program: a randomized controlled trial. International Journal of Integrated Care. 2018;18(s2):105. DOI: http://doi.org/10.5334/ijic.s2105
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Published on 23 Oct 2018.

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