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The dose of physical activity to minimise functional decline in older general medical patients receiving 24‐hr acute care: A systematic scoping review
Author(s) -
Ley Lenore,
Khaw Damien,
Duke Maxine,
Botti Mari
Publication year - 2019
Publication title -
journal of clinical nursing
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.94
H-Index - 102
eISSN - 1365-2702
pISSN - 0962-1067
DOI - 10.1111/jocn.14872
Subject(s) - medicine , acute care , gerontology , medline , intensive care medicine , older people , physical activity , nursing , physical therapy , health care , political science , law , economics , economic growth
Aims and objectives To identify evidence for a recommended and feasible activity dose to minimise functional decline in older hospitalised general medical patients. Background Quality 24‐hr care of older patients involves balancing activity to minimise functional decline, with rest to aid recovery. However, there is limited guidance regarding an optimal type and dose of activity to minimise functional decline in hospitalised elders receiving acute medical care. Design A systematic search and scoping review of the literature were conducted following Joanna Briggs methodological guidance. Methods The results were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) Statement. Study bias was determined using the Joanna Briggs Institute Critical Appraisal Tools. Results Fifteen primary studies of variable design, rigour and potential for bias were included. Study contexts were general medical wards ( n = 11, 73.3%), Acute care of the elderly unit ( n = 3, 20%) and a nursing unit ( n = 1, 6.7%) located in tertiary referral acute hospitals. Most participants were aged 75–84 years ( n = 10, 66%), had variable medical diagnoses and samples were either physically capable ( n = 4, 26.7%) of limited physical capability ( n = 1, 6.7%) or of mixed capability to mobilise independently ( n = 10, 66.7%). Walking at least twice a day for approximately 20 min in total appeared to be associated with less functional decline in older patients of variable physical capabilities, and the overall efficacy of twice‐daily exercise to reduce functional decline was supported. Conclusion The evidence tentatively supported walking for hospitalised elders, irrespective of physical capability, and based on one RCT, suggested likely benefits of graduated exercise in dependent elders. Insufficient evidence limits prescription of optimal doses of physical activity to minimise functional decline. Relevance to clinical practice This review could provide evidence for nurses to promote function in older patients by specifying a dose of physical activity to be undertaken in hospital.