Targeted individual exercise programmes for older medical patients are feasible, and may change hospital and patient outcomes: a service improvement project
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Background: The aim of this project was primarily to assess the feasibility of individual exercise programs for older hospitalised patients at risk of functional decline, and secondarily to evaluate impact on discharge outcomes. Methods: Design: Cohort service improvement project Setting: 500 bed acute metropolitan hospital Subjects: Patients aged 70 and older admitted to Flinders Medical Centre under the general medical, aged care and respiratory units from June to November 2006, at intermediate or high risk of functional decline, and able to commence exercise within 48 hours of admission Intervention: Functional Maintenance Program (FMP); an individually tailored exercise program to maintain functional mobility, prescribed and progressed by a physiotherapist, and supervised by an Allied Health Assistant (AHA), provided in addition to usual physiotherapy care Outcome measures: Feasibility (number of admissions suitable, commencing and complying with FMP). Impact (length of hospital stay (LOS), Aged Care Assessment Team (ACAT) referrals and approvals, hospital readmissions within 28 days, and functional mobility (Elderly Mobility Scale)) Data Analysis: Descriptive and logistic regression analysis Results: Of 1021 admissions of patients aged 70 or older to general medical, aged care and respiratory units, 22% (n = 220) were identified within 48 hours as suitable for FMP: 196 (89%) commenced FMP within 48 hours of admission (FMP patients); 24 (11%) received usual physiotherapy (usual care patients). Feasibility of individually tailored exercise programs for older medical patients was supported by high uptake (89%), low withdrawal (17%) shown by those who commenced FMP, and good compliance with exercise sessions (70%). Logistic regression analysis showed a statistically significant decreased likelihood of referral for nursing home admission (OR = 0.228, 95% CI 0.088–0.587) and decreased likelihood of approval for admission to residential care (OR = 0.307, 95% CI 0.115–0.822) in favour of FMP. Although trends of an average 15.7% LOS reduction, 8% fewer readmissions and improved functional mobility were demonstrated in favour of FMP patients, these results were not statistically significant. Conclusion: It is feasible to identify older medical patients likely to benefit from an exercise program to maintain functional abilities, and to commence within 48 hours of admission.