Journal of General Internal Medicine

, Volume 26, Issue 12, pp 1471–1478

Assessing Balance and Mobility to Track Illness and Recovery in Older Inpatients

  • Ruth E. Hubbard
  • Eamonn M. P. Eeles
  • Michael R. H. Rockwood
  • Nader Fallah
  • Elyse Ross
  • Arnold Mitnitski
  • Kenneth Rockwood
Original Research

DOI: 10.1007/s11606-011-1821-7

Cite this article as:
Hubbard, R.E., Eeles, E.M.P., Rockwood, M.R.H. et al. J GEN INTERN MED (2011) 26: 1471. doi:10.1007/s11606-011-1821-7

ABSTRACT

BACKGROUND

Archetypal symptoms and signs are commonly absent in frail older people who are acutely unwell. This challenges both recognition of illness and monitoring of disease progression in people at high risk of prolonged hospital stays, institutionalization and death.

OBJECTIVE

To determine whether bedside assessment of balance and mobility could track acute changes in the health status of older people admitted to hospital.

DESIGN

Prospective cohort study.

PARTICIPANTS

Four hundred nine patients, with a mean age of 81.8 years, admitted to general medical and rehabilitation wards at a tertiary care teaching hospital in Halifax, Nova Scotia. No patient refused assessment, and the only exclusion criterion was age.

INTERVENTIONS

The Hierarchical Assessment of Balance and Mobility (HABAM) was completed daily during the first 2 weeks of admission. For each patient, frailty status was measured on admission by a Frailty Index based on a Comprehensive Geriatric Assessment (FI-CGA).

MAIN MEASURES

Death and discharge destination.

KEY RESULTS

Poor performance in balance, transfers and mobility was associated with adverse outcomes. Forty-eight percent of patients with the lowest scores in all three domains died, compared with none with the highest scores. The relative risk of death for people who deteriorated during the first 48 h of admission was 17.1 (95% confidence interval: 4.9–60.3). Changes in HABAM scores were related to the discharge destination: patients discharged home showed the greatest rate of improvement, whereas those discharged to institutions stabilised at a lower level of performance. Fitter patients tended to have better performance on admission and faster recovery.

CONCLUSIONS

Daily bedside observation of mobility and balance allows assessment of acute changes in the health of older people. Frailty slows recovery of mobility and balance, and reduces recovery potential. By identifying patients most vulnerable to adverse outcomes, the HABAM and FI-CGA may facilitate risk stratification in older people admitted to hospital.

KEY WORDS

postural balancefrail elderlyhospitalsgeriatric assessment

Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Ruth E. Hubbard
    • 1
    • 2
  • Eamonn M. P. Eeles
    • 2
    • 3
  • Michael R. H. Rockwood
    • 1
  • Nader Fallah
    • 1
  • Elyse Ross
    • 1
  • Arnold Mitnitski
    • 1
    • 4
    • 5
  • Kenneth Rockwood
    • 1
    • 3
    • 4
    • 6
  1. 1.Geriatric Medicine Research UnitDalhousie University & Capital District Health AuthorityHalifaxCanada
  2. 2.Department of Geriatric Medicine, School of MedicineCardiff UniversityCardiffUK
  3. 3.Department of MedicineDalhousie UniversityHalifaxCanada
  4. 4.Division of Geriatric MedicineDalhousie UniversityHalifaxCanada
  5. 5.Department of Mathematics and StatisticsDalhousie UniversityHalifaxCanada
  6. 6.Centre for Health Care of the Elderly, Capital District Health AuthorityHalifaxCanada