R01AG073278

Randomized Trial of Assisted Ambulation to Improve Health Outcomes for Older Medical Inpatients - Project Summary/Abstract

For older adults, prolonged hospitalization can lead to a devastating loss of mobility and independence. Each year, 12 million adults over the age of 65 are hospitalized, and 30% are discharged to a post-acute care facility. One of the risks of hospitalization is bed rest, which is associated with a number of hospital-acquired complications, including falls, delirium, venous thrombosis, and skin breakdown.

Hospital mobility programs attempt to ambulate patients up to three times daily, but this work is generally assigned to nurses, who have many competing and often more pressing tasks. Consequently, ambulating patients is the most frequently overlooked nursing duty. This problem has been exacerbated by the COVID-19 pandemic and the resulting nursing shortage.

Small studies have examined the benefits of mobility technicians (MTs), whose sole job is to safely ambulate patients. These studies have demonstrated that MTs can increase steps taken, but they are too small to prove the impact of MTs on other outcomes, such as whether patients have in-hospital complications or whether they can go home instead of to a post-acute care facility. Hospitals are hesitant to adopt MT programs because they perceive them to be expensive and unproven.

We propose to conduct a large randomized trial to test the impact of MTs on short and intermediate-term outcomes for 3000 patients aged 65 years and older at 5 hospitals in 2 health systems. Patients will be randomized to receive supervised ambulation up to 3 times daily with an MT or to receive usual care. All participants will wear an accelerometer on their wrist to track their movement throughout the hospital stay.

The study has 3 aims. First, we will compare the mobility of patients at discharge (or 10 days) to assess the impact of the MTs on this outcome. We are particularly interested in whether the use of MTs will increase the proportion of patients who can go home vs. post-acute care, and whether the improvements in mobility are sustained at 30 days.

Second, we will use predictive modeling to identify which patients are most likely to benefit from this intervention.

Third, we will assess the impact of the intervention on overall costs associated with the episode of care, including inpatient costs and the 30 days after discharge. This information will be important to convince health systems to adopt this approach.

Cleveland Clinic Lerner College Of Medicine Of Case Western Reserve University

TO ENCOURAGE BIOMEDICAL, SOCIAL, AND BEHAVIORAL RESEARCH AND RESEARCH TRAINING DIRECTED TOWARD GREATER UNDERSTANDING OF THE AGING PROCESS AND THE DISEASES, SPECIAL PROBLEMS, AND NEEDS OF PEOPLE AS THEY AGE. THE NATIONAL INSTITUTE ON AGING HAS ESTABLISHED PROGRAMS TO PURSUE THESE GOALS. THE DIVISION OF AGING BIOLOGY EMPHASIZES UNDERSTANDING THE BASIC BIOLOGICAL PROCESSES OF AGING. THE DIVISION OF GERIATRICS AND CLINICAL GERONTOLOGY SUPPORTS RESEARCH TO IMPROVE THE ABILITIES OF HEALTH CARE PRACTITIONERS TO RESPOND TO THE DISEASES AND OTHER CLINICAL PROBLEMS OF OLDER PEOPLE. THE DIVISION OF BEHAVIORAL AND SOCIAL RESEARCH SUPPORTS RESEARCH THAT WILL LEAD TO GREATER UNDERSTANDING OF THE SOCIAL, CULTURAL, ECONOMIC AND PSYCHOLOGICAL FACTORS THAT AFFECT BOTH THE PROCESS OF GROWING OLD AND THE PLACE OF OLDER PEOPLE IN SOCIETY. THE DIVISION OF NEUROSCIENCE FOSTERS RESEARCH CONCERNED WITH THE AGE-RELATED CHANGES IN THE NERVOUS SYSTEM AS WELL AS THE RELATED SENSORY, PERCEPTUAL, AND COGNITIVE PROCESSES ASSOCIATED WITH AGING AND HAS A SPECIAL EMPHASIS ON ALZHEIMER'S DISEASE. SMALL BUSINESS INNOVATION RESEARCH (SBIR) PROGRAM: TO EXPAND AND IMPROVE THE SBIR PROGRAM, TO INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT, TO INCREASE SMALL BUSINESS PARTICIPATION IN FEDERAL RESEARCH AND DEVELOPMENT, AND TO FOSTER AND ENCOURAGE PARTICIPATION OF SOCIALLY AND ECONOMICALLY DISADVANTAGED SMALL BUSINESS CONCERNS AND WOMEN-OWNED SMALL BUSINESS CONCERNS IN TECHNOLOGICAL INNOVATION. SMALL BUSINESS TECHNOLOGY TRANSFER (STTR) PROGRAM: TO STIMULATE AND FOSTER SCIENTIFIC AND TECHNOLOGICAL INNOVATION THROUGH COOPERATIVE RESEARCH DEVELOPMENT CARRIED OUT BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS, TO FOSTER TECHNOLOGY TRANSFER BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS, TO INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT, AND TO FOSTER AND ENCOURAGE PARTICIPATION OF SOCIALLY AND ECONOMICALLY DISADVANTAGED SMALL BUSINESS CONCERNS AND WOMEN-OWNED SMALL BUSINESS CONCERNS IN TECHNOLOGICAL INNOVATION.

93.866 - Aging Research

National Institute on Aging (NIA) [HHS - NIH]

Cleveland, Ohio 44195 United States

Single Zip Code

Research Project Grant (Parent R01 Clinical Trial Required) (PA-20-183)

Amendment Since initial award the total obligations have increased 465% from $1,059,129 to $5,979,214.