Early Mobilization in Older Adults with Acute Cardiovascular Disease. (28th November 2020)

• Record Type: Journal Article
• Authors: Goldfarb, Michael; Semsar-kazerooni, Koorosh; Morais, José A; Dima, Diana
• Is Part Of: Age and ageing. Volume 50:Number 4(2021)
• Page Start: 1166
• Page End: 1172
• Publication Date: 2020-11-28
• Subjects: older people -- early mobilization -- functional capability -- acute cardiovascular disease -- cardiac intensive care unit; Aging -- Periodicals; Geriatrics -- Periodicals; 618.97
• DOI: 10.1093/ageing/afaa253
• Languages: English
• ISSNs: 0002-0729

Abstract

Abstract: Background: Early mobilization (EM) is beneficial in critical care units and in older hospitalized patients, but little is known about EM in older adults with acute cardiovascular disease. Methods: Consecutive admissions of adults ≥80 years old to a Cardiac Intensive Care Unit (CICU) prior to and following implementation of a nurse-driven EM program were reviewed. Mobility was measured using the Level of Function (LOF) Mobility Scale, which ranges from 0 (bed immobile) to 5 (able to walk >20 meters). The primary outcome was discharge home. Results: There were 412 patients included ( N = 234, intervention; N = 178, preintervention). There was no difference in age between groups (overall 86.3 ± 4.8 years old) or sex (overall female N = 215, 52.2%). In the intervention group, functional impairment was present in 89 patients (38.0%) prehospitalization and in 209 patients (89.3%) on admission. Nearly half of patients ( N = 107; 45.7%) improved their LOF by ≥1 during admission. Mobilization occurred during nearly all opportunities (838/850; 98.6%), and most mobility activities were completed (2, 207/2, 553; 86.4%). Adverse events were rare (5/2, 207 activities [0.2% adverse event rate]) and transient. Patients in the intervention group were more likely than patients in the preintervention group to be discharged home (74.4 vs. 65.7%, P = 0.047, respectively) and had a lower rate of in-hospital death (6.4 vs. 14.6%, P = 0.006, respectively). There was no difference in mean length of hospital stay, 30-day emergency department visit or hospital re-admission. Conclusion: EM is safe in older adults in the CICU and is associated with reduced discharge to healthcare facility and in-hospital mortality.