While hospitalization is often necessary, it can carry risks for older adults—around 30 percent of hospitalizations among older adults lead to a loss of ability to complete one of the activities of daily living (ADL, such as bathing or toileting independently). It appears that physical inactivity, which leads to atrophy and decline in muscle strength, may be one major cause of these hospital-acquired ADL disabilities. A recent study of hospitalized community-dwelling older adults explores the role that fear of falling may play in activity restriction (whether self-imposed or restricted by clinicians) in hospitals.
The study was based on interviews, the collection of medical and demographic data, and cognitive and physical assessments of 41 adults age 70 or older who were hospitalized. The researchers recruited participants without significant cognitive impairment, who lived independently in the community prior to hospitalization. Participants were interviewed about their fear of falling and about mobility and physical activity in general.
The interviews elicited several themes related to hospitalization and mobility. Fourteen participants self-limited their activity in the hospital because they did not see physical activity as a priority during a time of acute health needs. In contrast, a greater number of participants reported that they felt it was important to stay active during their time in the hospital, in order to retain or develop strength for when they leave the hospital. Participants also discussed the role that others (hospital staff and family members) can play in either encouraging physical activity or enabling inactivity. Participants also discussed hospital policies and the hospital environment that can either restrict or promote activity.
The authors argue that hospitals and other health care organizations should, when developing falls reduction protocols and other safety measures, take care not to discourage mobility.
Boltz M, Resnick B, Capezuti E, et al. Activity restriction vs. self-direction: hospitalised older adults’ response to fear of falling. International Journal of Older People Nursing. (2013). doi:10.1111/opn.12015.