Prognostic value of Braden Activity subscale for mobility status in hospitalized older adults
OBJECTIVES
To evaluate the predictive value of the Activity subscale of the Braden Scale for Predicting Pressure Sore Risk in assessing mobility impairment and recovery among hospitalized older adults.
DESIGN
Retrospective cohort study.
SETTING
UF Health Shands Hospital, University of Florida, Gainesville, Florida.
PATIENTS
19,769 older adults (≥65 years) hospitalized between January 2009 and April 2014.
MEASUREMENTS
Incident mobility impairment and recovery were assessed with the Braden Activity subscale (BAS) score that nurses use to grade patients at every shift change (~3 times/d). Posthospital mortality rate and discharge disposition were used to assess the prognostic value of the BAS.
RESULTS
Of the 10,717 study patients observed “walking frequently” at admission, 2218 (20.7%) developed incident mobility impairment. Of the other 9052 study patients, who were impaired at admission, 4734 (52.3%) recovered to a state of walking occasionally or frequently. Older adults who developed mobility impairment during hospitalization had an odds of death higher than that of those who remained mobile (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.08-1.39). This effect predominately occurred within the first 6 follow-up months. Older adults who recovered from mobility impairment had an odds of death lower than that of those who did not recover mobility in the hospital (OR, 0.54; 95% CI, 0.49-0.59). This effect was slightly stronger within the first 6 months after hospitalization.
CONCLUSIONS
Nurses’ BAS assessment of mobility status during hospitalization provides substantial prognostic value in hospitalized older adults. The BAS could be an efficient and valuable source of information about mobility status for targeting posthospital care of older adults. Journal of Hospital Medicine 2017;12:396-401. © 2017 Society of Hospital Medicine
© 2017 Society of Hospital Medicine
In-hospital mobility (walking and transferring) is an important modifiable factor for posthospital functional outcomes and mortality among older adults.1-4 In fact, daily mobility assessment has been considered for a standard clinical evaluation of the hospitalized older adult.5,6 This would provide a ready source for targeting patients at risk for mobility impairment and identifying strategies to prevent in-hospital mobility limitation and posthospital functional decline. Despite their potential importance, mobility assessment tools have not been readily adopted in the hospital setting.
There are various ways to assess mobility in hospital settings. Mobility tracking technology (radar and accelerometers) has demonstrated older adults have extremely low mobility during hospitalization. Although these objective methods provide an unbiased way to monitor physical activity level and track in-hospital mobility change,6-8 and have provided important information about mobility in the hospital, they are largely impractical in real-world settings.
While mobility technology appears to be advancing, there is a potential to assess in-hospital mobility using commonly administered and inexpensive tools. Many hospitals ask staff to regularly rate physical function (Braden and Morse score) as part of their standard-of-care procedures. The rating scales used have the potential to provide valuable information about mobility variations without using special equipment or burdening patients. The Braden Scale for Predicting Pressure Sore Risk is a good example of a validated assessment instrument that is better than nurses’ judgment, which is often confounded by nursing experience.9 This scale, which has 6 subscales (Sensory Perception, Moisture, Activity, Mobility, Nutrition, Friction and Shear), has shown high sensitivity in detecting patient condition changes in the clinical setting.10 The scale typically is used holistically to evaluate pressure ulcer risk, but the Activity subscale, which assesses mobility, could serve as a useful tool for predicting posthospital recovery and identifying needs for posthospital mobility interventions.
We conducted a study to evaluate the prognostic value of using the Braden Activity subscale (BAS) to identify in-hospital incident mobility impairment and recovery for predicting mortality and discharge status among hospitalized older adults.
METHODS
The University of Florida Gainesville Health Science Center Institutional Review Board reviewed and approved the study protocol as exempt from human subjects’ research.
Design and Setting
The design followed a retrospective cohort study in which hospitalized patients were evaluated at admission (baseline) and assessed throughout their stay for incident mobility impairment and recovery. Data were collected in older adults (≥65 years old) hospitalized at UF Health Shands Hospital (University of Florida), an 852-bed level I trauma center in Gainesville, Florida.
