An exercise program with patient's involvement and family support can modify the cognitive and affective trajectory of acutely hospitalized older medical patients: a pilot study.
BACKGROUND
Most hospitalized older adults have reduced functional and physiological reserves, rendering them more vulnerable to the effects of a series of circumstances beyond the existence of health conditions unrelated to the reason for the hospitalization, usually worsening the hospitalization outcome. Despite the theoretical support for the idea that mobility improvement in the hospitalized patient carries multiple benefits, this idea has not been fully translated into clinical practice.


OBJECTIVE
Our objective was to assess if an exercise intervention involving patients and families could modify the cognitive and affective progression of hospitalized older patients, from admission to discharge and 30 days after discharge.


METHODS
This was a prospective intervention study with blinded outcome progression. Patients were recruited over a 3-month period and prospectively followed up. The intervention consisted in a supervised individualized graduated exercise program and education of ward and team staff, patients and caregivers to actively encourage mobility and functional independence.


RESULTS
A total of 29 patients were recruited. Mean age was 86.1 (SD 4.92), and 18 (62 %) were women. At discharge, we found a significant improvement in Mini-mental State Examination (p = 0.008), Trail making Test-A (p = 0.03), and verbal fluency (p = 0.019). One month after discharge, Geriatric Depression Scale-Yesavage and Delirium Rating Scale-revised-98 remained statistically different.


CONCLUSIONS
This pilot study shows that an exercise program is feasible, and can be suitable to prevent cognitive and affective decline during acute hospitalization of older adults. It is a challenge for the new models of hospitalization to change the actual disease-centered view to the patient-centered view, optimizing traditionally neglected aspects such as functional, cognitive and affective recovery after hospitalization.
Department of Geriatrics, Complejo Hospitalario de Navarra, Pamplona, Spain. mvelilla@yahoo.com.|Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Pamplona, Spain. mvelilla@yahoo.com.|IdiSNa, Navarra for Health Research, Pamplona, Spain. mvelilla@yahoo.com.
Nicolás
N
Martínez-Velilla
Department of Physiology, Universidad del País Vasco, Bizkaia Campus, Bilbao, Spain.
Mirian
M
Garrués-Irisarri
Navarrabiomed-Fundación Miguel Servet, Pamplona, Spain.|Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Pamplona, Spain.|IdiSNa, Navarra for Health Research, Pamplona, Spain.
Berta
B
Ibañez-Beroiz
Health Science Department, Universidad Publica de Navarra, Pamplona, Spain.
Jenifer
J
Gil-Cabañas
Residencia Beloso Alto, Pamplona, Spain.
Analía
A
Richarte-García
Radiology Department, Clínica San Miguel, Pamplona, Spain.
Fernando
F
Idoate-Saralegui
Clínica Rehabilitación, Servicio Navarro de Salud, Pamplona, Spain.
Patricia Corte
PC
de Paz
Navarrabiomed-Fundación Miguel Servet, Pamplona, Spain.|Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Pamplona, Spain.|IdiSNa, Navarra for Health Research, Pamplona, Spain.
Koldo
K
Cambra
D000369:Aged, 80 and over; D003071:Cognition / Q000502:physiology; D015444:Exercise; D005190:Family; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D010865:Pilot Projects; D011446:Prospective Studies
Aging; Cognitive trajectory; Exercise; Hospitalized