Despite hospitals' best efforts, there is little proof that policies to inhibit patient mobility actually prevent falls and may actually increase the risk of serious side effects, according to Sharon K. Inouye, MD, MPH, Director of the Aging Brain Center at the Institute for Aging Research, Hebrew SeniorLife.
"According to a 2009 estimate, hospital patients spend over 95% of their time in bed. In -hospital immobility is one of several factors theorized to give rise to the "posthospital syndrome," a transient state of heightened vulnerability following hospitalization that is associated with an increased risk of functional decline, medical adverse events, and hospital readmission," writes Inouye in the April 24 issue of JAMA Internal Medicine.
Writing with co-authors Matthew Growdon, MD, MPH of Brigham and Women's Hospital and Ron Shorr, MD, MS, University of Florida, Dr. Inouye, who is renowned for her work in preventing and recognizing delirium, illuminates the unfortunate stream of consequences that hospitals unintentionally set in motion in their attempts to prevent patient falls.
Inouye cites several studies that demonstrate that such policies increase the risks of many serious side effects, and that promoting mobility in hospitals may actually help to prevent injurious falls in the long run.
Inouye recommends that the Centers for Medicaid and Medicare develop quality measures that promote mobility rather than incentivizing keeping patients in their beds. These measures could include supervised walks with mobility aids and trained staff or volunteers. Inouye also cautions against the use of bed and chair alarms, which have proven ineffective at reducing falls, often promote immobility, and contribute to stress and alarm fatigue in nurses.
"With the rapidly aging population, this issue will become all the more important--presenting the opportunity for health systems to align care with outcomes that matter to patients," added Dr. Growdon.
Dr. Inouye is the Director of the Aging Brain Center at the Institute for Aging Research, Hebrew SeniorLife in Boston, Massachusetts. She holds the Milton and Shirley F. Levy Family Chair and is a Professor of Medicine at Harvard Medical School (Beth Israel Deaconess Medical Center). Her research focuses on delirium and functional decline in hospitalized older patients, resulting in more than 250 peer-reviewed original articles to date.
About the Institute for Aging Research
Scientists at the Institute for Aging Research seek to transform the human experience of aging by conducting research that will ensure a life of health, dignity and productivity into advanced age. The Institute carries out rigorous studies that discover the mechanisms of age-related disease and disability; lead to the prevention, treatment and cure of disease; advance the standard of care for older people; and inform public decision-making. The Aging Brain Center within IFAR studies cognitive aging and conditions affecting brain health.
About Hebrew SeniorLife
Hebrew SeniorLife, an affiliate of Harvard Medical School, is a national senior services leader uniquely dedicated to rethinking, researching and redefining the possibilities of aging. Founded in Boston in 1903, the nonprofit, non-sectarian organization today provides communities and health care for seniors, research into aging, and education for geriatric care providers. For more information about Hebrew SeniorLife, visit http://www.hebrewseniorlife.org, follow us on Twitter @H_SeniorLife, like us on Facebook or read our blog.
JAMA Internal Medicine