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Invited Commentary
July 2016

Activating Hospitalized Older Patients to Confront the Epidemic of Low Mobility

Author Affiliations
  • 1Division of Hospital Medicine, University of California, San Francisco
JAMA Intern Med. 2016;176(7):928-929. doi:10.1001/jamainternmed.2016.1874

Bedrest is toxic to older adults. Initially a clinical observation,1 this statement has become axiomatic in geriatric medicine and now rests on nearly 3 decades of rigorous scientific investigation demonstrating underlying pathophysiologic mechanisms of immobility and clinical outcomes research demonstrating associations with disability, nursing home placement, and mortality.2,3 Indeed, half of permanent disability in older adults begins with hospitalization,4 and 2 of 3 older adults who experience hospital-acquired disability will be placed in a nursing home or dead within a year of discharge.5 Despite this robust literature on mechanisms and outcomes, the literature on interventions to improve hospital mobility in older adults has remained almost completely undeveloped. This paradox is puzzling especially in light of the prevalence of low mobility. Moreover, Brown et al6 have previously described low hospital mobility as an epidemic given their finding that older adults spend a mean of 45 minutes per day out of their hospital bed, which is less than 5% of a 24-hour period.

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