Centre for Applied Research on Social Sciences and Law

Factors Associated with Step Numbers in Acutely Hospitalized Older Adults: The Hospital-Activities of Daily Living Study


<p>OBJECTIVES: To determine the number of steps taken by older patients in hospital and 1 week after discharge; to identify factors associated with step numbers after discharge; and to examine the association between functional decline and step numbers after discharge.</p><p>DESIGN: Prospective observational cohort study conducted in 2015-2017.</p><p>SETTING AND PARTICIPANTS: Older adults (≥70 years of age) acutely hospitalized for at least 48 hours at internal, cardiology, or geriatric wards in 6 Dutch hospitals.</p><p>METHODS: Steps were counted using the Fitbit Flex accelerometer during hospitalization and 1 week after discharge. Demographic, somatic, physical, and psychosocial factors were assessed during hospitalization. Functional decline was determined 1 month after discharge using the Katz activities of daily living index.</p><p>RESULTS: The analytic sample included 188 participants [mean age (standard deviation) 79.1 (6.7)]. One month postdischarge, 33 out of 174 participants (19%) experienced functional decline. The median number of steps was 656 [interquartile range (IQR), 250-1146] at the last day of hospitalization. This increased to 1750 (IQR 675-4114) steps 1 day postdischarge, and to 1997 (IQR 938-4098) steps 7 days postdischarge. Age [β = -57.93; 95% confidence interval (CI) -111.15 to -4.71], physical performance (β = 224.95; 95% CI 117.79-332.11), and steps in hospital (β = 0.76; 95% CI 0.46-1.06) were associated with steps postdischarge. There was a significant association between step numbers after discharge and functional decline 1 month after discharge (β = -1400; 95% CI -2380 to -420; P = .005).</p><p>CONCLUSIONS AND IMPLICATIONS: Among acutely hospitalized older adults, step numbers double 1 day postdischarge, indicating that their capacity is underutilized during hospitalization. Physical performance and physical activity during hospitalization are key to increasing the number of steps postdischarge. The number of steps 1 week after discharge is a promising indicator of functional decline 1 month after discharge.</p>

Reference Kolk, D., Aarden, J. J., MacNeil-Vroomen, J. L., Reichardt, L. A., van Seben, R., van der Schaaf, M., van der Esch, M., Twisk, J. W. R., Bosch, J. A., Buurman, B. M., Engelbert, R. H. H., & Hospital-ADL study group (2021). Factors Associated with Step Numbers in Acutely Hospitalized Older Adults: The Hospital-Activities of Daily Living Study. Journal of the American Medical Directors Association, 22(2), 425-432. https://doi.org/10.1016/j.jamda.2020.06.027
Published by  Urban Vitality 1 February 2021

Publication date

Feb 2021


Hospital-ADL study group
Daisy Kolk
Janet L MacNeil-Vroomen
Lucienne A Reichardt
Rosanne van Seben
Jos W R Twisk
Jos A Bosch
Bianca M Buurman
Janet L. MacNeil-Vroomen
Lucienne A. Reichardt
Jos W.R. Twisk
Jos A. Bosch
Bianca M. Buurman


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