For older adults, prolonged hospitalization can lead to a devastating loss of mobility and independence. Each year, 12 million adults over the age of 65 are hospitalized, and 30% are discharged to a post-acute care facility.
One of the risks of hospitalization is bed rest, which is associated with a number of hospital-acquired complications, including falls, delirium, venous thrombosis and skin breakdown.
A $7.4 million grant from the National Institute on Aging will support a large randomized trial to test the impact of mobility technicians on short-term and intermediate-term outcomes for 3,000 patients aged 65 years and older at five hospitals in two health systems.
The study will be carried out at Cleveland Clinic’s main campus, in addition to its Fairview, Hillcrest and Marymount hospitals, along with Baystate Medical Center in Springfield, Mass.
Hospital mobility programs attempt to walk patients up to three times daily, but this work is generally assigned to nurses who have competing and often more pressing tasks. Consequently, walking patients is often overlooked. This problem has been exacerbated by the COVID-19 pandemic and the resulting nursing shortage.
Small studies have examined the benefits of mobility technicians, whose sole job is to safely walk patients. These studies have demonstrated that mobility technicians can increase steps taken, but the studies are too small to prove the impact of mobility technicians on other outcomes, such as whether patients have in-hospital complications or whether they can go home instead of to a post-acute care facility.
In the upcoming study, patients will be randomized to receive supervised walking up to three times daily with a mobility technician or to receive usual care. All participants will wear an accelerometer on their wrist to track their movement throughout the hospital stay.
The study aims to compare the mobility of patients at discharge (or 10 days) to assess the impact of the mobility technicians on this outcome. Of particular interest is whether the use of mobility techs will increase the number of patients who can go home vs. post-acute care, and whether the improvements in mobility are sustained at 30 days.
Researchers also will use predictive modeling to identify which patients are most likely to benefit from this intervention. Additionally, the study will assess the impact of the intervention on overall costs associated with the episode of care, including inpatient costs and 30 days after discharge.
Michael Rothberg, M.D., MPH, vice chair for research, Cleveland Clinic Community Care, will lead the study, the largest of its kind on hospital mobility.
“This study will test a new way to preserve mobility of older patients in the hospital,” Dr. Rothberg said. “We believe we can prevent many of the harms of hospitalization simply by getting patients up and moving. If our study is successful it will change our approach to mobility across the country.”
Dr. Rothberg also serves as director of Cleveland Clinic’s Value-Based Care Research.