Introduction
Methods
Patients
Age, mean (SD), range years | 84.0 (6.8) 68–99 |
Sex female, N (%) | 12 (60) |
Height, mean (SD) cm | 165.2 (8.4) |
Weight, mean (SD) kg | 70.5 (17.8) |
Days since admission, mean (SD), time frame days | 4.6 (2.2) (2–9) |
Length of stay, mean (SD) days | 16.9 (16.9) |
Number of diagnoses, mean (SD) N | 5.2 (1.4) |
DemTecta, mean (SD) score | 7.4 (1.9) |
DEMMIb, mean (SD) score | 48.8 (14.7) |
Barthel Indexc, mean (SD) score | 50.0 (21.5) |
Admitted from home, N (%) | 16 (80) |
Discharge destination home, N (%) | 8 (40) |
Institutionalized, N (%) | 12 (60) |
Primary reason for admission, N (%) | |
Urinary tract infection | 2 (10) |
Fall | 6 (30) |
Renal insufficiency | 1 (5) |
Pain | 1 (5) |
Collapse | 1 (5) |
Stroke | 1 (5) |
Hypertension | 2 (10) |
Anxiety disorder | 1 (5) |
Infection | 5 (25) |
Staff participants
Outcome measures
Observation
Activity behavior and difficulty of action
Activity | Category | Classification | Level of difficulty |
---|---|---|---|
(1) Lying in bed | Downtime in bed | Passive/iatrogenica | No action |
(2) Talk, read, watch TV, eat in bed | Passive | Nontherapeutic action | |
(3) Supported sitting in bed | |||
(4) Supported sitting out of bed | Sitting | Active/iatrogenica | Minimal therapeutic action |
(5) Transfer with support or hoist | Active | ||
(6) Unsupported sitting in bed | Active/iatrogenica | Moderate therapeutic action | |
(7) Unsupported sitting out of bed | Active | ||
(8) Supported standing | Upright activity | ||
(9) Supported walking | |||
(10) Supported bending knees | |||
(11) Unsupported standing activities | High therapeutic action | ||
(12) Unsupported walking | |||
(13) Unsupported bending knees | |||
(14) Unsupported transfer with feet on floor |
Context information
Location and persons attending the patient
Statistical analysis
Results
Patient data
Activity behavior, persons attending the patient, location, and context of action
Activity | Duration in minutes M (SD) | % of the observed time M (SD) |
---|---|---|
Downtime | 236.2 (121.9) | 45.0 |
Sitting | 216.0 (115.6) | 41.1 |
Upright | 72.7 (65.1) | 13.9 |
Attending person | ||
No one | 342.0 (96.6) | 65.1 |
Relatives/Friends | 52.5 (64.6) | 10.0 |
Service team membera | 45.0 (54.0) | 8.6 |
Therapist | 37.5 (22.5) | 7.1 |
Nurse | 37.5 (28.6) | 7.1 |
Physician | 10.5 (18.9) | 2.0 |
Locationb | ||
Bedroom | 396.9 (81.6) | 75.6 |
Belonging bathroom | 19.5 (18.9) | 3.7 |
Common room | 50.2 (61.3) | 9.5 |
Hallway | 39.0 (50.7) | 7.4 |
Examination roomc | 7.5 (15.7) | 1.4 |
Off wardd | 12.6 (21.9) | 2.4 |
Context of action | ||
Sleeping | 99.7 (78.3) | 19.0 |
Activities of daily living | 93.7 (57.6) | 17.8 |
Hospital routines | 67.5 (41.1) | 12.9 |
Neuropsychiatric symptomse | 126.0 (82.8) | 24.0 |
Leisure activitiesf | 138.0 (91.9) | 26.3 |
Factors Associated with Patients’ Activity Behavior
Difficulty level of action
Nurse | Physician | Therapist | Service | Relatives | None | |||
No action | −2.9** | / | −5.1*** | −5.9*** | −4.6*** | 11.0*** | ||
Nontherapeutic action | / | / | / | −2.7** | 6.7*** | −2.5* | ||
Minimal therapeutic action | / | / | 2.5* | 11.4*** | / | −8.3*** | ||
Moderate therapeutic action | 2.0* | / | / | / | / | / | ||
High therapeutic action | / | / | 4.2*** | / | / | −2.5* | ||
χ2(20) =283.23, p <0.001, V =0.32 | ||||||||
Room | Bathroom | Com.room | Hallway | Exa.room | O. ward | |||
No action | 11.1*** | −3.8*** | −6.3*** | −5.5*** | −2.3* | −3.1*** | ||
Nontherapeutic action | 5.0*** | / | −2.9** | −2.5* | / | / | ||
Minimal therapeutic action | −7.8*** | −2.2* | 9.4*** | / | 4.8*** | 5.7*** | ||
Moderate therapeutic action | −2.0* | / | 2.5* | / | / | / | ||
High therapeutic action | −11.1*** | 9.3*** | −2.6** | 12.4*** | / | 2.3* | ||
χ2(20) =490.92, p <0.001, V =0.42 | ||||||||
9AM | 10AM | 11AM | 1PM | 2PM | 3PM | 4PM | 6PM | |
No action | −3.2* | −2.2* | −3.6*** | 3.7*** | 3.5*** | 2.0* | / | / |
Nontherapeutic action | −2.4* | / | −2.2* | −2.0* | / | 2.4* | 2.5* | 2.9** |
Minimal therapeutic action | 3.8*** | / | 4.0*** | / | −2.1* | −2.4* | −2.6** | / |
Moderate therapeutic action | 2.6** | / | / | / | / | / | / | / |
High therapeutic action | / | 2.7** | / | / | / | / | / | / |
χ2(28) =128.04, p <0.001, V =0.21 |
Daytime
Context of action
Sleeping | ADL | Leisure time | Hospital routines | Neuropsychiatric symptoms | ||
---|---|---|---|---|---|---|
No action | 17.5*** | −9.1*** | −11.1*** | −4.6*** | 7.1*** | χ2(16) =604.96, p <0.001, V =0.47 |
Nontherap. action | −4.3*** | −2.5* | 8.5*** | / | −2.0* | |
Min. therap. action | −5.5*** | / | 5.5*** | 5.3*** | −5.4*** | |
Mod. therap. action | −8.6*** | 5.3*** | 4.0*** | / | / | |
High therap. action | −3.9*** | 8.5*** | −4.1*** | 3.5*** | −2.5* | |
Downtime | 14.2*** | −10.2*** | −5.5*** | −4.9*** | 5.6*** | χ2(8) =405.13, p <0.001, V =0.54 |
Sitting | −10.7*** | 3.5*** | 9.5*** | / | −4.3*** | |
Upright | −5.1*** | 9.6*** | −5.6*** | 4.7*** | / | |
Active | −14.0*** | 9.5*** | 5.8*** | 4.5*** | −5.2*** | χ2(8) = 359.73, p < 0.001, V = 0.51 |
Passive | 14.7*** | −10.6*** | −5.3*** | −5.7*** | 5.9*** | |
Iatrogenic | −2.0* | 3.4*** | / | 3.7*** | −2.3* | |
9AM | −3.4*** | 4.6*** | / | / | / | χ2(28) =154.86, p <0.001, V =0.24 |
10AM | −2.5* | / | / | 5.6*** | / | |
11AM | −2.2* | 2.6** | / | 3.6*** | −2.5* | |
1PM | 5.1*** | / | −2.7** | / | / | |
2PM | 4.5*** | −2.3* | / | / | / | |
3PM | / | / | / | / | / | |
4PM | / | / | / | / | / | |
6PM | / | / | / | −3.2** | 3.5*** |
Interview data
Discussion
Persons attending the patient
Location and daytime
Proposed measures
Limitations
Conclusion
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Patient sedentariness is associated with time spent alone, in the patient room, during the afternoon and by NPS such as apathy.
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Meaningful activities for the patient as well as staff involved with the patient are missing during the afternoon, which might lead to sedentariness. This could be addressed by split therapy sessions taking place in the afternoon or more personnel.
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Prolonged sitting might also occur due to competency restrictions, such as service staff not being allowed to mobilize the patient or due to time constraints in caring procedures.
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Physical activity, especially upright activity is insufficiently promoted by relatives and physicians.