An Intervention to Improve Mobility of Older Hospitalized Patients

Low mobility during an acute care hospitalization is very frequent, particularly among older patients, and associated with adverse outcomes, such as persistent functional decline, institutionalization and death. However, increasing hospital mobility remains challenging because of the multiple existing barriers.The goal of this clinical trial is to test the effect of a multilevel intervention to increase hospital mobility, which addresses modifiable barriers and facilitators and does not require unavailable additional resources.This study aims to answer whether this intervention can improve mobility and patient-relevant outcomes such as life-space mobility and functional status.The multilevel intervention will target:The patients, who will receive an information booklet, a customizable diary, an exercise booklet and an iPad with access to the videos of the exercise booklet.The healthcare professionals (nursing staff and physicians) who will complete an e-learning, receive an oral presentation on the intervention, and receive a "mobility checklist" that reminds them of what they should assess daily regarding mobility.The hospital environment, where posters will be hung in the wards, including walking itineraries with quizzes on topics of interest to older adults.In a first phase, the intervention will be pilot-tested in one ward of each hospital. The intervention will then be adapted based on patient and healthcare professional feedback.In a second phase, the intervention will be tested in a cluster randomized controlled trial, and compared to standard of care.

Inclusion Criteria:Admission to a general internal medicine ward of a participating hospitalAge ≥60 yearsBeing ambulatory during the 2 weeks before admission (self-report)Living in the community (not in a nursing home or another institution) for at least the last 30 days prior to admissionAbility to understand French or GermanPlanned length of stay at least 3 days after enrolmentPossibility to start the study within 48 hours after admission to the general internal medicine wardWritten informed consent signed by participant or proxy/legal representative in case of cognitive impairmentExclusion Criteria:Medical contraindication to walk (e.g., wound not allowing loading weight)Wheelchair-boundEnd-of-lifeSevere psychiatric disorder (severe depression, schizophrenia, psychosis)Delirium (presence of features 1 and 2, and either 3 or 4 of the CAM)Dementia (Mini-Cog <3), except if a proxy can be actively involved in the intervention and provides consent (for the randomized trial only, not for the pilot study)