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Admission and discharge mobility of frail hospitalized older adults

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CE Objectives and Evaluation Form appear on page 164.

Admission and Discharge

Mobility of Frail Hospitalized
Older Adults
Bonnie L. Callen Thelma J. Wells Susan Hughes
Jane E. Mahoney Myra Enloe

Functional decline during hos-

pitaiization is an important clini-
cal problem with potential long-
I mmobility is a common occur-
rence among hospitalized elders
and may contribute to multiple,
municate due to limited mobility
language in nursing practice. When
mobility is conceptualized as a
lasting undesirable outcomes in long-lasting adverse physiologic and continuum progressing from bed-
frail elders. However, little is functional outcomes. Functional bound to independent walking, a
known about the change in mobil- decline during hospitaiization is an single scale could contribute to
ity during hospitaiization and the important clinical problem with more precise documentation of
association with discharge .status. potential long-lasting undesirable changes in mobility. Thus, changes
A Mobility Classification Tool has outcomes, but little is known about in mobility and outcomes of these
been developed that categorizes the change in mobility during hos- changes could be monitored and
progression of patients' in-hospital pitaiization and the association evaluated.
mobility using a 5-point scale. The with the elder's discharge status.
validity and clinical usefulness of Furthermore, changes in mobility Background
this tool was evaluated in a sam- are difficult to quantify and com- Bed rest in young healthy
ple of 60 frail older adults hospi-
talized for medical illness. The
tool allows nurses to assess, quan- Myra Enloe, MS, RN, is Patient Safety Officer, University of Wisconsin Hospital,
tify, and communicate mobility Madison. WI.
levels and changes in mobility
Sus£ui Hnghes, MS, RN, is a Senior Research Specialist, University of Wisconsin-
more accurately. Madison, School of Nursing, Madison, WI.

Funding: This study was funded by the University of Wisconsin Graduate School and
the University of Wisconsin Hospitals and Clinics Department of Nursing.
Bonnie L Callen, PhD, RN, is an
Publisher's Note: Publication of this article was supported by a grant provided by
Assistant Professor, University of
Nurse Competence in Aging, a 5-year initiative funded by The Atlantic Philanthropies
Tennessee College of Nursing, Knoxville,
(USA) Inc., awarded to the American Nurses Association (ANA) through the American
TN. Nurses Foundation (ANP"), and representing a strategic alliance between ANA, the
American Nurses Credentiaiing Center (ANCC), and the John A. Hartford Foundation
Jane E. Mahoney, MD, is an Assistant institute for Geriatric Nursing, New York University, The Steinhardt School of
Professor of Geriatrics, University of Education, Division of Nursing.
Wisconsin-Madison, WI.
For more information, contact the John A. Hartford Foundation Institute for Geriatric
Thelma J. Wells, PhD, RN, FAAN, is
Nursing, New York University, The Steinhardt School of Education, Division of Nursing,
Professor Emerita of Nursing, University
246 Greene Street, 5th Floor, New York. NY 10003, or call (212) 998-9018, or email hart-
of Wisconsin-Madison, WI. [email protected] or access the Web site at www.hartfordign.org

156 MEDSURG Nursing—June 2004—Vol 13/No. 3

 Admission and Discharge Mobility of Frail Hospitalized Older Adults

adults results in declines in mus- only 12% received physical thera- severity of adverse effects associ-
cle mass and strength (Bloomfield, py (Lazarus, Murphy, Coletta, ated with immobility during hospi-
1997; LeBlanc et al., 1992), slowed McQuade, & Culpepper, 1991). talization, it becomes critical that
gait speed (Dupui, Montoya, About one-third of hospital- tools be developed and tested to
Costes-Salon, Severac, & Guell, ized older adults experience a measure mobility, and methods
1992), orthostatic incompetence decline in function as measured tested to prevent immobility-relat-
(Creditor, 1993), increased body by activities of daily living (ADLs) ed consequences in the hospital
sway (Dupui et al., 1992), impaired (McVey, Becker, Saltz, Feussner, & setting.
psychomotor coordination (Zubek, Cohen, 1989; Sager et al., 1996b).
Bayer. Mllstein, &Shephard, 1969), During hospitalization, older Purpose
and depression (Ishizaki et al., adults are at high risk for loss of The purpose of this study was
1994). Little is known about the walking, toileting, and transferring to evaluate the validity and clini-
impact of bed rest during hospital- skills. Studies have shown that cal usefulness of the Mobility
ization in older adults, but it is 15% of older adults hospitalized Classification Tool on admission
assumed that the negative effects for medical illness become newly and at discharge for frail older
of bed rest on healthy young adults dependent on others to walk adults being cared for on an acute
are compounded for elders. across a room (Mahoney, Sager, & care medical hospital unit.
Hospitalization for acute illness is a Jalaluddin, 1998; McVey et al., Specific goals were to:
critical event for older adults, 1989). Decline in transferring and
bringing witb it a high likelihood of toileting occurs with similar fre- • Characterize the relationship of
short-term or long-term loss of quency (Hirsch, Sommers, Oisen, admission mobility level to
function. Many hospitalized older Mullen, & Winograd, 1990; McVey patient characteristics at
adults spend a great deal of their et al., 1989; Sager et al., 1996b). admission.
time in bed. Undesirable out- Decline in ADL function during • Describe the change in mobility
comes associated with hospital- hospitalization is associated with level during hospitalization.
ization include loss of walking multiple adverse outcomes, • Examine the relationship of
independence, increased risk of including discharge to a nursing admission and discharge mobil-
nursing home placement (Sager et home and persistent functional ity level to discharge location.
al., 1996a), and increased risk of decline 3 months after discharge • Examine the relationship of
falls, both during and after hospi- (Landefeld, Palmer, Kresevic, admission and discharge mobil-
taiization (Mahoney et ai., 2000). Fortinsky, & Kowal, 1995; Rudberg, ity level to discharge function
These adverse consequences are Sager, & Zbang, 1996; Sager et al., and length of hospital stay.
related to multiple factors, includ- 1996a). Specifically, loss of walking
ing illness, new medications, and independence is strongly associat- Methods
iatrogenic complications, but it is ed with continued walking depen- Institutional review board
likely that bed rest during hospi- dence 3 months following dis- (IRB) approval was obtained at
talization contributes substantial- charge from acute care (Mahoney the study site, a major teaching
ly to deconditioning, falls, and et al., 1998). An additional nega- and tertiary care hospital in
nursing home placement. tive consequence of functional Wisconsin. A prospective cohort
decline during hospitalization is of patients aged 65 or older admit-
Available data suggest that the increased risk for falls follow- ted to a medical unit was screened
provision of mobility to hospital- ing hospital discharge (Mahoney with the Hospital Admission Risk
ized patients is markedly inade- et al., 2000; Mahoney, Sager, Profile (HARP) from June through
quate. In a 1991 study of older Dunham, & Johnson, 1994). August 2001. The HARP is a risk
adult medical-surgical patients at assessment tool used on hospital
five hospitals, Lazarus and col- It is projected that by the year admission that predicts functional
leagues found that 24% of patients 2030, 1 in 5 people will be 65 years decline and discharge to a nursing
had no ambulation noted in nurs- of age or older. Further, in 2000, home. This tool classifies patients
ing records during the first 7 hos- Americans 65 years of age and as low, intermediate, or high risk
pital days. On 23% of their days in older had four times the number for functional decline based on
the hospital, patients did not get of hospitalization days as did three factors: age, cognition, and
out of bed; according to chart those under the age of 65 (Federal pre-hospital independent activi-
review, these elders did not ambu- Interagency Forum on Aging- ties of daily living (IADLs) (Sager
late at all on half of their hospital Related Statistics, 2000). Given the et al., 1996b). Inclusion criteria for
days. Of patients who were chair changing demographics of the this study were: (a) age 65 and
or bedbound for an entire week, population and the potential older, (b) admitted from home,

MEDSURG Nursing—June 2004—Vol. 13/No. 3 157

 Admission and Discharge Mobility of Frail Hospitalized Older Adults

sems
Table 1.
Mobility Classification Tool

Check mobility Passive Active Assisted Independent

level for each Bedbound Transfer Transfer Walking Walking
shift and initial Level 1 Level 2 Level 3 Level 4 Level 5
Bedbound or Bed-to-chair Bed-to-chair with Assisted (hands Walks without
confined to bed activity with NO partial to full on); full weight assistance
on medical/ weight bearing weight bearing bearing and
nursing orders ambutation
A Patient depen- Transferred to Two-person Walk; with two Walk independent
Maximum dent: Staff pro- cardiac chair assist; stand and assist in room only
restriction or vides all turning, pivot to chair,
dependence positioning, and wheelchair, or
ROM commode

B Patient partici- Mechanical or One-person Walk; with Walk out of

pates with staff three-person lift assist; stand and one assist room; < 1 hall
assist in turning, to chair, wheel- pivot to chair, length
positioning, and chair, or com- wheelchair, or
ROM mode commode
C Patient is Transfer to chair, One-person Walk; with Walk out of
Least restricted/ independent wheelchair, or standby assist to standby assist room; > 1 hall
Least depen- in bed commode with chair, wheelchair, length,
dence two-person assist or commode

Terms:
• Independence: Patient able to perform alone
• Assistance: Nurse touching patient and providing effort for mobility

How to use this form:

• Determine Level (1 thru 5)
• Determine level of dependence (A, B, C)

and (c) at intermediate or high ty. Limited chart data on mobility bedbound to completely indepen-
risk according to the HARP. were found. Also noted was the dent. A five-level Mobility
Exclusion criteria were (a) short lack of clarity relating to mobility Classification Tool was developed
stay (length of hospital stay 48 terms (for example, up ad lib, may (see Table 1). Five senior nurses
hours or less), and (b) terminally ambulate, chair). How did nurses assigned to leadership clinical roles
ill (life expectancy of less than 30 interpret these terms? An explo- on the unit, each with greater than
days as determined by the admit- ration of the literature found only 10 years of experience in medical-
ting nurse). limited discussion of mobility as a surgical nursing, provided feed-
concept in nursing (Ouellet & back on content and language.
Measures Rush, 1992). Limited descriptive The tool was implemented on the
Mobility Classification Tool. In patient mobility terminology in unit. The nurses provided written
1997, a collaborative interdiscipli- nursing could be found. For exam- feedback as they used the tool.
nary research team at the ple, basic activities of daily living Feedback contributed to modifica-
University of Wisconsin Hospital described patient mobility in two tions. This tool classifies patient
and Clinics began an examination categories: walking and transfers. mobility as: (1) bedbound. (2)
of the mobility language used in Through a series of research bed-to-chair with no weight bearing,
acute care. A chart review was team discussions, and with input (3) bed-to-chair with partial weight
conducted for the 289 subjects from expert staff nurses, mobility bearing. (4) assisted (hands on) full
who had entered a previous study was conceptualized as a continu- weight bearing, and (5) walks with-
to gather hospital data on mobili- um from completely dependent or out assistance. Subcategories A to C

158 MEDSURG Nursing—June 2004—Vol. 13/No. 3

 Admission and Discharge Mobility of Frail Hospitalized Older Adults

Table 2. Instrumental Activities of Daily

Participant Measures Living (lADLs). On hospital admis-
sion, the admitting nurse asked
n % Mean SD about lADLs 2 weeks prior to
Abbreviated Mini-Mental State Examination 54*
admission. lADLs assess the levels
14.26 6.06
{RangeO-21)
at which an older adult can per-
form seven tasks required for
Activities of Daily Living 53* 2.28 2.15 independent living and are more
(Range 0 - 6 ) sophisticated than ADLs. These
functions include using the tele-
Instrumental Activities of Daily Living 56* 2.38 2.05 phone, getting to places beyond
(Range 0 - 7 ) walking distance, shopping for
groceries, preparing meals, doing
HARP Category housework, taking medications,
Intermediate 28 46.7 and managing finances. Scores
High 32 53.3 range from 0 to 7, with higher
Although HARP scores were available for 60 subjects, subscores were not
scores indicating greater indepen-
recorded for all subjects. dence (Lawton & Brody, 1969)
(see Table 2). Items requiring no
assistance were scored 1, while
items requiring some assistance
under each level described the levels (no help needed, help need- or which the person is unable to
degree of assistance or indepen- ed, or unable to do). Admission do receive a score of 0.
dence for that level. Originally con- ADLs are strongly linked to dis-
ceptualized as a potential 15-point charge and post-discharge ADL The Hospital Admission Risk
scale, in practice, the subcategories function (Hirsch et al., 1990: Sager Profile (HARP) categorizes older
seemed to reflect nurse manage- et al., 1996a). The summation adults into risk categories based
ment of patient mobility. Thus, score measures the number of on age, cognition (abbreviated
while the potential for further tool activities for which no help was MMSE) at time of hospital admis-
refinement exists, the tool func- needed. Scores range from 0 to 6, sion, and IADLs 2 weeks prior to
tioned as a I to 5 continuum for this with higher scores indicating hospital admission. HARP catego-
study which focused on validity. greater independence. The scale rizes patients into three cate-
Inter-rater reliability was demonstrates excellent reliability, gories: high risk, intermediate
assessed for 14 pairs of nursing validity, and predictive validity, risk, or low risk. Scores range from
staff raters. Agreement on catego- and has shown sensitivity to 0 to 5, with higher scores indicat-
ry and subcategory was S6%. In change for hospital and post-hos- ing greater risk (see Table 2). This
the two cases where raters did not pital use (Inouye et al., 1993; Katz tool has been used to identify
agree, the mobility aide, a special- etal., 1970; Wu etal., 2000). patients at risk for functional
ly trained nursing assistant Abbreviated Mini-Mental State decline following hospitalization
assigned solely to assist patients Examination (MMSE). Cognition (Sager et al., 1996a).
in ambulating, rated mobility level was measured using the abbreviat-
higher than other nursing staff ed MMSE, a 21-item version of the Procedure
(one RN, one other nursing assis- MMSE. Scores range from 0 to 21, On admission, data were col-
tant) caring for the patient. Scores with higher scores indicating lected by staff nurses and special-
were validated by the trained greater cognitive function (see ly trained nursing assistants.
mobility aides during actual daily Table 2). A score of 14 or less Mobility level and ADLs were
mobilization. implies cognitive dysfunction assessed daily by nursing staff.
Activities of Daily Living. Katz (Folstein, Folstein, & McHugh, Nursing assistants received a full
Activities of Daily Living (ADLs) 1975; Sager et al., 1996b). The day of training from members of
were assessed on admission and abbreviated MMSE omits language the research team on mobility
discharge for six items (bathing, items because of the difficulty of classification and mobility levels,
dressing, toileting, eating, trans- collecting these in the hospital. as well as appropriate ambulation
ferring, and walking across a small Correlation between the 21-item and transfer techniques. Super-
room) (Katz, Downs, Cash, & MMSE and the standard 30-item vised each day by the charge
(irotz, 1970) (see Table 2). This MMSE has been reported as r^().9O, nurse and monitored by the
scale measured each ADL on three (p<0.001) (Sager et al., 1996b). research staff, the aides would

MEDSUBG Nursing—June 2004—Vol 13/No. 3 159

 Admission and Discharge Mobility of Frail Hospitalized Older Adults

determine the mobility level from Table 3.

the previous day and then check Participant Characteristics {N=60)
with the nurse for any changes.
They would then see the patients, n % Mean SD
get them up, and record the mobil- Age 80.48 7.80
ity levels for that day. ADLs were
collected and recorded as part of Female 38 63
routine unit care. Caucasian 59 98
Sample and .setting. The setting
for this study was one medical unit Primary Admission Diagnoses
with 28 beds at a Midwestern uni- Pulmonary 12 20
versity-based health care center.
From June to August 2001, 123 GI 11 18
patients ages 65 and older admitted Circulatory 10 17
to this unit from home were evalu-
ated. Of these, 13 were short stay Musculoskeletal 6 10
(hospital stay of less than 48 Other 21 35
hours), and 4 were terminally ill
(life expectancy less than 30
days). Of the remaining 103, 60 hospitalization, the last ADL and
were at intermediate or high risk was 2.7 (p=0.055), indicating a
according to HARP and composed mobility level collected (either on trend for lower mobility to be
the sample of this study. Subject the day of discharge or the day associated with higher risk for
characteristics on admission are prior to discharge) were defined functional decline during hospital-
reported in Table 3. Results of the as discharge ADLs and mobility ization. There were no significant
four specific purposes of this level. gender differences between mobil-
study will next be summarized. Relationship of mobility level ity levels at admission.
to patient characteristics on hospi- Change in mobility level during
The study was approved by tat admission (.see Table 4). At hos- hospitalization. The percentage of
the IRB of the University of pital admission, 15% of the patients at each mobility level
Wisconsin Hospital and Clinics. patients were bedbound (Level 1), demonstrates an overall improve-
Consent was not considered nec- 20% were unable to bear weight ment in mobility. The number of
essary because all mobility and (Level 2), 12% were able to bear bedbound patients was reduced
ambulation was part of a unit-wide partial weight (Level 3), 37% were 10% (15% on admission to 5% on
improvement program. able to walk with assistance (Level discharge). Correspondingly, the
4), and 8% were able to walk inde- percentage of independent patients
Results pendently (Level 5). Higher mobil- increased from 8.3% on admission
Descriptive statistics were ity level at admission was associ- to 13.3% on discharge. See Figure 1
used to summarize the data. Chi- ated with a higher score on ADLs for detail on all mobility cate-
square analysis was used to exam- (p^O.OOO), as well as a higher cog- gories at hospital admission and
ine differences on admission in nitive status as measured by the discharge; the percentage distrib-
gender. HARP category, and dis- abbreviated MMSE (p=0.025). On ution is similar comparing admis-
charge location among the mobili- admission, the HARP, which sion and discharge mobility. The
ty levels. One-way analysis of vari- screens for age, cognition, and improvement from admission
ance (ANOVA) was used to look at pre-hospital IADLs, indicated that (mean mobility level 3.04, SD 1.29)
differences in age, ADLs, IADLs, those who were bedbound to discharge (mean mobility level
abbreviated MMSE, and length of (Mobility Level 1) were most likely 3.45, SD 1.10) was statistically sig-
stay among mobility levels. A to be at high risk (78%), while nificant (t-2.91; /?=005). Little
paired samples t-test was used to those able to ambulate indepen- recovery of independence in walk-
examine the changes in mobility dently (Mobility Level 5) were ing occurred among those who
levels between admission and dis- least likely (20%) to be at high risk were less than independent at
charge. Pearson r was used to for functional decline. The mean admission. Of the 51 subjects who
examine correlations between admission mobility level for inter- were less than independent at
mobility levels and discharge mediate-risk patients according to admission, only 4 (8%) achieved
ADLs. Because ADLs and mobility the HARP screening was 3.4; the independence in walking in an
levels were collected daily during mean for high-risk HARP patients average length of stay of 8 days.

160 MEDSURG Nursing—June 2004—Vol. 13/No. 3

 Admission and Discharge Mobility of Frail Hospitalized Older Aduits

Table 4.
Relationship of Mobility Level to Patient Characteristics on Hospital Admission

Passive Active Assisted Independent

Bedbound Transfer Transfer Walking Walking
Level 1 Level 2 ' Level 3 Level 4 Level 5
n 9 12 7 22 5
Age (mean) 82.67 77.89 81.00 81.63 79.00 0.516
Gender
Female 66.70 58.30 85.70 63.60 40.00 0.581
Male 33.30 41.70 U.30 36.40 60.00 0.581
ADL (mean) 1.13 1.36 1.71 3.00 6.00 0.000
lADL {mean) 2.00 2.00 1.78 2.21 4.14 0.307
MMSE (mean) 11.63 9.60 17.00 15.57 17.00 0.025
HARP
High {%) 77.80 58.30 57.10 50.00 20.00 0.299

Figure 1. Relationship of admission and

Mobility Level on Admission and Discharge discharge mobility level to dis-
charge function and length of stay
50 in hospital. On both admission and
*-< 40 discharge, mobility level was
C strongly correlated with discharge
0) 30 ADL scores. Admission mobility
u level was strongly correlated with
0) discharge ADLs (r-0.66, p=0.000).
Q. 20
10 Discharge mobility level was simi-
larly correlated with discharge
0
ADLs (r=0.73, p-0.000). In other
Bedbound Passive Active Assisted Independent words, a strong relationship exists
Transfer Transfer Walking Walking between a patient's mobility level
and his or her functional level
Mobility Level measured by ADLs. Differences in
length of stay between mobility
I Admission • Discharge levels was not statistically signifi-
cant, F (4, 50) ^ 1.762, p-0.151.

Discussion
Relationship of admission and partial weight bearing). 63% of The validity and clinical use-
discharge mobility level to discharge those at Level 4 (assisted full fulness of a Mobility Classification
location (see Figure 2). Of those weight bearing), and only 13% of Tool was evaluated in 60 frail older
classified at discharge by the those who could walk without adults hospitalized for medicai ill-
Mobility Classification Tool as Level assistance went to a nursing home ness. This tool demonstrated
1 (bedbound). 100% were newly (X^-17.31, p=0.002). Thus, mobility good inter-rater reliability and
placed to a nursing home. For those level was strongly associated with good construct validity as illus-
at Level 2 at discharge (bed-to-chair discharge location. Mobility level at trated by the association with
with no weight bearing), 89% went admission was also significantly admission ADLs and the abbrevi-
to a nursing home, while 91% of associated with discharge to a nurs- ated MMSE. Additionally, both
those at Level 3 (bed-to-chair with ing home (y;= 2..S3, p=0.014). admission and discharge mobility

MEDSURG Nursing—June 2004—Vol. 13/No. 3 161

 Admission and Discharge Mobility of Frail Hospitalized Older Adults

levels were associated with dis- Figure 2.

charge location. It is important to Percentage of Subjects Newly Discharged to an Inpatient Facility by
note that all of these patients lived Admission and Discharge Mobility Level
at home prior to admission.
When change in mobility for 100
patients at intermediate and high c 80
risk (HARP) was analyzed, marked v 60
u
mobility impairment at admission 40
and little change in mobility dur- 20
ing hospitalization were noted. 0
According to the Mobility Classi- Bedbound Passive Active Assisted Independent
fication Tool, patients only im- Transfer Transfer Walking Walking
proved one-half a level on average,
indicating limited recovery of Mobility Level
independent walking during hos-
pitalization. Very few patients pro- [Admission • Discharge
gressed to independent walking.
Limited recovery of independent
walking was strongly associated
with new placement to a nursing (Johnson et al., 2000), While physi- ADLs for assessing mobility. It
home at hospital discharge. These cal therapy had related terminokv enables nursing staff to quantify
data suggest that the ability to gy. it focused more narrowly and and communicate more accurate-
walk independently may be a criti- did not meet either the breadth or ly the mobility levels and changes
cal factor in discharge disposition. frame of nursing action. In con- in mobility of elders hospitalized
They also indicate that in this trast, the Mobility Tool encapsu- in acute care. Because walking
group, dependence in walking at lates classification mobility in one during hospitalization may be key
the time of admission is a sentinel scale reflecting a progression from to discharge placement, identify-
occurrence demonstrating a high bedbound to independence in ing changes in mobility of even
risk for nursing home placement ambulation. This scale reflects the half a level can direct nursing care
among frail older adults. A third trajectory of mobility progression and the amount of assistance
implication of these data is that for acutely ill patients in the hos- needed by hospitalized frail
greater attention is needed to pital setting. elders. The tool's precision may
patients' independence in walking make it highly useful for research,
during hospitalization. Further Limitations of this study are
the lack of information on perfor- but it does need further develop-
study is needed to determine if ment. This study was a first step in
this would decrease the need for mance of ADLs 2 weeks prior to
admission to assess function prior the examination of this tool, but
discharge to a nursing home. additional testing is needed.
to the illness that required hospi-
talization. Presence of a mobility Results focused only on patients
The Nursing Outcomes at intermediate or high risk for
Classification (NOC) (Johnson, aide whose sole function was to
ambulate patients may have influ- functional decline; future research
Mass, & Moorhead, 2000). pub- should also include those at low
lished after the conceptualization enced care. Ongoing research also
may have been a factor in the risk for functional decline.
of this mobility classification tool,
uses two scales in the domain of usual care on this unit. Care may Consistent use of this tool will
functional health to classify mobil- have been affected and perhaps allow important questions to be
ity, one for those able to walk and improved by daily attention to answered. Can mobility be
another for those using a wheel- mobility; however, little progress improved in acute care? Will that
chair for mobility. Ambulation: was shown in the subjects of this improvement increase the proba-
Walking, defined as the ability to study. A third limitation is that all bility of the patient's discharge to a
walk from place to place, uses a patients in this study were on a home setting rather than to a nurs-
five-point scale to classify walking medical unit. Patients with med- ing home? With increasing health
from dependent to completely ical conditions may differ from care dollars being spent on older
independent. A second division of those admitted to surgical or adults, future research should
mobility is Ambulation.' Wheelchair, other units. focus on improving mobility during
defined as the ability to move from This Mobility Classification is hospitalization to maintain their
place to place in a wheelchair a useful tool, more precise than independence. •

162 MEDSURG Nursing—June 2004—Vol. 13/No. 3

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Inouye, S.K., Wagner, D.R.. Acampora. D., Horwitz. R.I., Cooney L.M., 230-236.
Jr, Hurst, L.D., et al. (1993). A predictive index for functional
decline in hospitalized elderly medical patients. Journal of General
Internal t[/ledicine. 8(^2), 645-652.
(shizaki. Y, Fukuoka, H., Katsura, T, Nishimura, Y., Kiriyama, M.,
Higurashi. M., et al. (1994). Psychological effects of bed rest in
young healthy subjects. Acta Physiologica Scandinavlc.
Supplementurn(6^6Q). 83-87.
Johnson, M., Mass, M., S Moorhead, S. (Eds.). (2000). Nursing out-
comes classification (NOCj (2nd ed,). St. Louis: Mosby, Inc.
Katz, S., Downs. TD., Cash. H.R., & Grotz. R,C. (1970). Progress in
development of the index of adi. Gerontologist. 10{^). 20-30.
Landefeld. C.S.. Palmer. R.M.. Kresevic, D,M.. Fortinsky R.H., & Kowai,
J. (1995), A randomized trial of care in a hospital medical unit
especially designed to improve the functional outcomes of acute-
ly ill older patients. New England Journal of Medicine. 332(20),
1338-1344.
SOME NURSES MANAGE MORE
Lawton, M.P, & Brody, E.M. (1969). Assessment of oider people: Self- THAN JUST PATIENT CARE. THEY
maintaining and instrumental activzities of daily living. Gerontologist,
9(3). 179-186, MANAGE ARMY HOSPITALS.
Lazarus, B.A., Murphy. J,B., Coletta, E.M.. McQuade, W.H., & in fact, some Army Nurses run
Culpepper, L. (1991).The provision of physical activity to hospital-
Army hospitals. You'll join as a
ized elderly patients. ,4rc/7/ves of/nferna/Med/c/ne, ?5/(12),2452-
2456. commissioned officer and others will
LeBlanc, A.D.. Schneider, VS., Evans, H,J., Pientok. C, Rowe, R., look to you for leadership. Simply
Spector, E., et al. (1992). Regional changes in muscle mass fol- put, it's a fast track for nurses
lowing 17 weeks of bed rest. Journal of Applied Physiology, 73(5), looking to take charge. In addition,
2172-2178. you'll receive:
Mahoney, J., Sager, M.. Dunham, N.C, & Johnson, J. (1994). Risk of
falls after hospital discharge. Journal of the American Geriatrics
Society. 42(3). 269-274. • Low-cost life insurance
Mahoney, J-E,, Palfa, M., Johnson. J., Jalaluddin, M.. Gray, S,, Park, S,, • Worldwide travel oppoftunities
et al. (2000). Temporal association between hospitalization and
rate of falls after discharge. Archives of Internal Medicine. 160( 18), • No-cost or low-cost medical and dental care for you
2788-2795. and yojr family
Mahoney, J.E.. Sager, M.A., & Jalaluddin, M. (1998). New walking • Non-contributory retirement benefits with 20 years
dependence associated with hospltaiization for acute illness: of qjalifying service
Incidence and significance. Journal of Gerontology, 53A, M307-
M312. • 30 days of paid vacation titne earned annjally
McVey L.J., Becker, PM.. Saitz, C.C, Feussner, J,R,, & Cohen, H.J.
(1989). Effect of a geriatric consultation team on functional status To find out more, or to speak to an Army Health Care
of elderly hospitalized patients. A randomized, controlled clinical Recruiter, call 800-796-8867 or visit
\r\a\. Annals of Internal Medicine. nO(1), 79-84, healthcare,goarmy.com/hct/44
Ouellet, L.L.. & Rush, K.L. (1992). A synthesis of selected literature on
mobility: A basis for studying impaired mobility. Nursing Diagnosis,
©2003. Paid tor b/ trie United States flriry All fights reserved.
3(2). 72-80. AN ARMY OF ONE

MEDSURG Nursing—June 2004—Vol. 13/No, 3 163

 Admission and Discharge Mobility of Frail Hospitalized Older Adults

MSN J406 Answer/Evaluation Form:

Admission and Discharge Mobility of Frail
Hospitalized Older Adults
This test may be copied for use by ottiers. Objectives
This educational activity is
designed for nurses and other health
COMPLETE THE FOLLOWING: care professionals who are involved
with the admission and discharge
Name: _ mobility of frail hospitalized older
adults. For those wishing to obtain CE
Address: credit, an evaluation follows. After
studying the information presented in
City: State: .Zip:. this article, the nurse will be able to:
1. Discuss immobility in older adults.
Preferred telephone: (Home)_ (Work). 2. Describe the validity and clinical
usefulness of the Mobility
AMSN Member Expiration Date: Classification Tool on admission
and at discharge.
Registration fee: AMSN/ISONG Member: $ 7.00
Nonmember: $10.00
V y CE Instructions
Answer Form:
I.To receive continuing education
1. Name one new detail (item, issue, or phenomenon) that you credit for individual study after
learned by completing this activity. reading the article, complete the
answer/evaluation form to the left.

2. Detach and send the answer/evalu-

ation form along with a check or
money order payable to AMSN to
2. How will you apply the information from this learning activity to t\AEDSURG Nursing. CE Series, East
Holly Avenue Box 56, Pitman, NJ
your practice?
08071-0056.
a. Patient education.
b. Staff education. 3. Test returns must be postmarked by
June 30, 2006. Upon completion of
c. Improve my patient care.
the answer/evaluation form, a cer-
d. In my educational course work. tificate for 1.7 contact hour(s) will
e. Other: Please describe. be awarded and sent to you.

3. I verify that I have completed this activity.

(Signature) This independent study activity is pro-
vided by Anthony J. Jannetti, Inc.,
Strongly Strongly which is accredited as a provider of con-
Evaluation disagree agree tinuing nursing education by the
The offering met the stated objectives. American Nurses Credentialing Center's
Commission on Accreditation (ANCC-
1. Discuss immobility in older adults.
COA). Anthony J. Jannetti. Inc. is an
2. Describe the validity and clinical usefulness approved provider of continuing educa-
of the Mobility Classification Tool on tion by the California Board of
admission and at discharge. Registered Nursing, Provider #CEP5387.
3. The material was new for me.
4. Time required to complete reading assignment and posttest: Minutes This article was reviewed and formatted
for contact hour credit by Dottie
Comments Roberts, MSN, MACI, CMSRN, RN,BC,
ONC, MEDSURG Nursing Editor; and
Sally S. Russell, MN, CMSRN, AMSN
Education Director.

164 MEDSURG Nursing—June 2004—Vol. 13/No. 3

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