SHM Converge Conference Coverage

Activity Barriers in Hospitalized Older Adults

Miranda Manier, BA

Key Highlights:

  • 81.5% of hospitalized older adults preferred to maintain or increase their usual activity levels during their hospital stay.
  • Despite this, 67.1% of participants expected to be less active while hospitalized.
  • Nearly all patients (98.6%) were placed on fall precautions, though only 7.1% had a documented fall history.
  • The most common self-reported barriers to activity were lack of energy (31.4%), poor health (27.1%), and a perceived need for rest (17.1%).
  • High rates of multimorbidity, psychotropic medication use, and opiate exposure were observed, potentially contributing to decreased mobility.

A new mixed methods analysis revealed that a majority of hospitalized older adults desire to maintain or increase their physical activity levels during inpatient care, despite facing multiple barriers and expectations of reduced mobility. This study was presented at the Society of Hospital Medicine's SHM Converge 2025 on April 23, in Las Vegas, NV.

Conducted at a large tertiary academic medical center from July to August 2024, the study included medical inpatients aged 62 years and older with a hospital stay of at least 2 days. Patients with significant cognitive impairment were excluded. Using a structured questionnaire, researchers assessed participants’ prior function, activity preferences and expectations, and perceived barriers to physical activity. The Katz Index of Independence in Activities of Daily Living (ADL), AM-PAC “6-Clicks” score, and Johns Hopkins Highest Level of Mobility (JH-HLM) score were used to evaluate function and mobility. Descriptive statistics summarized participant responses and clinical data.

Of 81 patients screened, 70 (86.4%) completed interviews. The median age was 74 years, with slightly more than half identifying as female (51%). The majority of participants were either overweight (26.1%) or obese (40.6%). High multimorbidity was prevalent, with 81.4% having a Charlson Comorbidity Index score greater than three. Depression (38.6%) and neurological disorders (20.0%) were notable comorbidities. Nearly all patients (98.6%) were placed on fall precautions, although only 7.1% had a documented history of falls. Use of psychotherapeutic drugs (50.0%) and opiates (72.9%) was common. The median Katz ADL Index was five, suggesting mostly independent prior function.

Functional assessments revealed a median AM-PAC score of 18 and a JH-HLM score of 6, indicating that most patients could walk at least 10 steps. Nonetheless, 67.1% expected to be less active than usual during hospitalization. In contrast, 81.5% expressed a desire to maintain or increase pre-hospital activity levels. Commonly cited barriers included lack of energy (31.4%), poor health (27.1%), and the need for rest (17.1%), with additional concerns about pain, time constraints, and fear of injury.

“These findings highlight the need for targeted interventions to overcome biopsychosocial barriers and enhance physical activity among hospitalized older adults,” the study authors concluded.

Reference

Denton T, Tian S, Taylor S, Paje D. Older adult patients’ perspectives on physical activity during hospitalization: a mixed methods analysis. Paper presented at: Society of Hospital Medicine's SHM Converge 2025; April 22-25, 2025; Las Vegas, NV. Accessed April 22, 2025. https://shmconverge.hospitalmedicine.org/