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Published in: BMC Geriatrics 1/2012

Open Access 01-12-2012 | Study protocol

Activity in GEriatric acute CARe (AGECAR): rationale, design and methods

Authors: Steven J Fleck, Natalia Bustamante-Ara, Javier Ortiz, María-Teresa Vidán, Alejandro Lucia, José A Serra-Rexach

Published in: BMC Geriatrics | Issue 1/2012

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Abstract

Background

The Activity in GEriatric acute CARe (AGECAR) is a randomised control trial to assess the effectiveness of an intrahospital strength and walk program during short hospital stays for improving functional capacity of patients aged 75 years or older.

Methods/Design

Patients aged 75 years or older admitted for a short hospital stay (≤14 days) will be randomly assigned to either a usual care (control) group or an intervention (training) group. Participants allocated in the usual care group will receive normal hospital care and participants allocated in the intervention group will perform multiple sessions per day of lower limb strength training (standing from a seated position) and walking (10 min bouts) while hospitalized. The primary outcome to be assessed pre and post of the hospital stay will be functional capacity, using the Short Physical Performance Battery (SPPB), and time to walk 10 meters. Besides length of hospitalization, the secondary outcomes that will also be assessed at hospital admission and discharge will be pulmonary ventilation (forced expiratory volume in one second, FEV1) and peripheral oxygen saturation. The secondary outcomes that will be assessed by telephone interview three months after discharge will be mortality, number of falls since discharge, and ability to cope with activities of daily living (ADLs, using the Katz ADL score and Barthel ADL index).

Discussion

Results will help to better understand the potential of regular physical activity during a short hospital stay for improving functional capacity in old patients. The increase in life expectancy has resulted in a large segment of the population being over 75 years of age and an increase in hospitalization of this same age group. This calls attention to health care systems and public health policymakers to focus on promoting methods to improve the functional capacity of this population.

Trial registration

ClinicalTrials.gov ID: NCT01374893.
Appendix
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Literature
1.
3.
go back to reference Volpato S, Onder G, Cavalieri M, Guerra G, Sioulis F, Maraldi C, Zuliani G, Fellin R, Italian Group of Pharmacoepidemiology in the Elderly Study (GIFA): Characteristics of nondisabled older patients developing new disability associated with medical illnesses and hospitalization. J Gen Intern Med. 2007, 22 (5): 668-674. 10.1007/s11606-007-0152-1.CrossRefPubMedPubMedCentral Volpato S, Onder G, Cavalieri M, Guerra G, Sioulis F, Maraldi C, Zuliani G, Fellin R, Italian Group of Pharmacoepidemiology in the Elderly Study (GIFA): Characteristics of nondisabled older patients developing new disability associated with medical illnesses and hospitalization. J Gen Intern Med. 2007, 22 (5): 668-674. 10.1007/s11606-007-0152-1.CrossRefPubMedPubMedCentral
4.
go back to reference Leff B, Burton L, Mader SL, Naughton B, Burl J, Greenough WB: Comparison of functional outcomes associated with hospital at home care and traditional acute hospital care. J Am Geriatr Soc. 2009, 57(2): 273-278.CrossRef Leff B, Burton L, Mader SL, Naughton B, Burl J, Greenough WB: Comparison of functional outcomes associated with hospital at home care and traditional acute hospital care. J Am Geriatr Soc. 2009, 57(2): 273-278.CrossRef
5.
go back to reference Sonnenblick M, Raveh D, Gratch L, Yinnon A: Clinical and demographic characteristics of elderly patients hospitalised in an internal medicine department in Israel. Int J Clin Pract. 2007, 61 (2): 247-254. 10.1111/j.1742-1241.2006.00925.x.CrossRefPubMed Sonnenblick M, Raveh D, Gratch L, Yinnon A: Clinical and demographic characteristics of elderly patients hospitalised in an internal medicine department in Israel. Int J Clin Pract. 2007, 61 (2): 247-254. 10.1111/j.1742-1241.2006.00925.x.CrossRefPubMed
6.
go back to reference Brown CJ, Friedkin RJ, Inouye SK: Prevalence and outcomes of low mobility in hospitalized older patients. J Am Geriatr Soc. 2004, 52 (8): 1263-1270. 10.1111/j.1532-5415.2004.52354.x.CrossRefPubMed Brown CJ, Friedkin RJ, Inouye SK: Prevalence and outcomes of low mobility in hospitalized older patients. J Am Geriatr Soc. 2004, 52 (8): 1263-1270. 10.1111/j.1532-5415.2004.52354.x.CrossRefPubMed
7.
go back to reference Kortebein P, Ferrando A, Lombeida J, Wolfe R, Evans WJ: Effect of 10 days of bed rest on skeletal muscle in healthy older adults. JAMA. 2007, 297 (16): 1772-1774.CrossRefPubMed Kortebein P, Ferrando A, Lombeida J, Wolfe R, Evans WJ: Effect of 10 days of bed rest on skeletal muscle in healthy older adults. JAMA. 2007, 297 (16): 1772-1774.CrossRefPubMed
8.
go back to reference Zisberg A, Shadmi E, Sinoff G, Gur-Yaish N, Srulovici E, Admi H: Low mobility during hospitalization and functional decline in older adults. J Am Geriatr Soc. 2011, 59 (2): 266-273. 10.1111/j.1532-5415.2010.03276.x.CrossRefPubMed Zisberg A, Shadmi E, Sinoff G, Gur-Yaish N, Srulovici E, Admi H: Low mobility during hospitalization and functional decline in older adults. J Am Geriatr Soc. 2011, 59 (2): 266-273. 10.1111/j.1532-5415.2010.03276.x.CrossRefPubMed
9.
go back to reference Muller EA: Influence of training and of inactivity on muscle strength. Arch Phys Med Rehabil. 1970, 51 (8): 449-462.PubMed Muller EA: Influence of training and of inactivity on muscle strength. Arch Phys Med Rehabil. 1970, 51 (8): 449-462.PubMed
10.
go back to reference Carlson JE, Zocchi KA, Bettencourt DM, Gambrel ML, Freeman JL, Zhang D, Goodwin JS: Measuring frailty in the hospitalized elderly: concept of functional homeostasis. Am J Phys Med Rehabil. 1998, 77 (3): 252-257. 10.1097/00002060-199805000-00012.CrossRefPubMed Carlson JE, Zocchi KA, Bettencourt DM, Gambrel ML, Freeman JL, Zhang D, Goodwin JS: Measuring frailty in the hospitalized elderly: concept of functional homeostasis. Am J Phys Med Rehabil. 1998, 77 (3): 252-257. 10.1097/00002060-199805000-00012.CrossRefPubMed
11.
go back to reference Comette P, D’Hoore W, Malhomme B, Van Pee D, Meert P, Swine C: Differential risk factors for early and later hospital readmission of older patients. Aging Clin Exp Res. 2005, 17 (4): 322-328.CrossRefPubMed Comette P, D’Hoore W, Malhomme B, Van Pee D, Meert P, Swine C: Differential risk factors for early and later hospital readmission of older patients. Aging Clin Exp Res. 2005, 17 (4): 322-328.CrossRefPubMed
12.
go back to reference Covinsky KE, Palmer RM, Fortinsky RH, Counsell SR, Stewart AL, Kresevic D, Burant CJ, Landefeld CS: Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc. 2003, 51 (4): 451-458. 10.1046/j.1532-5415.2003.51152.x.CrossRefPubMed Covinsky KE, Palmer RM, Fortinsky RH, Counsell SR, Stewart AL, Kresevic D, Burant CJ, Landefeld CS: Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc. 2003, 51 (4): 451-458. 10.1046/j.1532-5415.2003.51152.x.CrossRefPubMed
13.
go back to reference McCusker J, Kakuma R, Abrahamowicz M: Predictors of functional decline in hospitalized elderly patients: a systematic review. J Gerontol A Biol Sci Med Sci. 2002, 57 (9): M569-M577. 10.1093/gerona/57.9.M569.CrossRefPubMed McCusker J, Kakuma R, Abrahamowicz M: Predictors of functional decline in hospitalized elderly patients: a systematic review. J Gerontol A Biol Sci Med Sci. 2002, 57 (9): M569-M577. 10.1093/gerona/57.9.M569.CrossRefPubMed
14.
go back to reference Mudge AM, O’Rourke P, Denaro CP: Timing and risk factors for functional changes associated with medical hospitalization in older patients. J Gerontol A Biol Sci Med Sci. 2010, 65 (8): 866-872.CrossRefPubMed Mudge AM, O’Rourke P, Denaro CP: Timing and risk factors for functional changes associated with medical hospitalization in older patients. J Gerontol A Biol Sci Med Sci. 2010, 65 (8): 866-872.CrossRefPubMed
15.
go back to reference Sleiman I, Rozzini R, Barbisoni P, Morandi A, Ricci A, Giordano A, Trabucchi M: Functional trajectories during hospitalization: a prognostic sign for elderly patients. J Gerontol A Biol Sci Med Sci. 2009, 64 (6): 659-663.CrossRefPubMed Sleiman I, Rozzini R, Barbisoni P, Morandi A, Ricci A, Giordano A, Trabucchi M: Functional trajectories during hospitalization: a prognostic sign for elderly patients. J Gerontol A Biol Sci Med Sci. 2009, 64 (6): 659-663.CrossRefPubMed
16.
go back to reference Brown CJ, Redden DT, Flood KL, Allman RM: The underrecognized epidemic of low mobility during hospitalization of older adults. J Am Geriatr Soc. 2009, 57 (9): 1660-1665. 10.1111/j.1532-5415.2009.02393.x.CrossRefPubMed Brown CJ, Redden DT, Flood KL, Allman RM: The underrecognized epidemic of low mobility during hospitalization of older adults. J Am Geriatr Soc. 2009, 57 (9): 1660-1665. 10.1111/j.1532-5415.2009.02393.x.CrossRefPubMed
17.
go back to reference Callen BL, Mahoney JE, Grieves CB, Wells TJ, Enloe M: Frequency of hallway ambulation by hospitalized older adults on medical units of an academic hospital. Geriatr Nurs. 2004, 25 (4): 212-217. 10.1016/j.gerinurse.2004.06.016.CrossRefPubMed Callen BL, Mahoney JE, Grieves CB, Wells TJ, Enloe M: Frequency of hallway ambulation by hospitalized older adults on medical units of an academic hospital. Geriatr Nurs. 2004, 25 (4): 212-217. 10.1016/j.gerinurse.2004.06.016.CrossRefPubMed
18.
go back to reference Bachmann S, Finger C, Huss A, Egger M, Stuck AE, Clough-Gorr KM: Inpatient rehabilitation specifically designed for geriatric patients: systematic review and meta-analysis of randomised controlled trials. BMJ. 2010, 340: c1718-10.1136/bmj.c1718.CrossRefPubMedPubMedCentral Bachmann S, Finger C, Huss A, Egger M, Stuck AE, Clough-Gorr KM: Inpatient rehabilitation specifically designed for geriatric patients: systematic review and meta-analysis of randomised controlled trials. BMJ. 2010, 340: c1718-10.1136/bmj.c1718.CrossRefPubMedPubMedCentral
19.
go back to reference Reid KF, Naumova EN, Carabello RJ, Phillips EM, Fielding RA: Lower extremity muscle mass predicts functional performance in mobility-limited elders. J Nutr Health Aging. 2008, 12 (7): 493-498. 10.1007/BF02982711.CrossRefPubMedPubMedCentral Reid KF, Naumova EN, Carabello RJ, Phillips EM, Fielding RA: Lower extremity muscle mass predicts functional performance in mobility-limited elders. J Nutr Health Aging. 2008, 12 (7): 493-498. 10.1007/BF02982711.CrossRefPubMedPubMedCentral
20.
go back to reference Laukkanen P, Heikkinen E, Kauppinen M: Muscle strength and mobility as predictors of survival in 75–84-year-old people. Age Ageing. 1995, 24 (6): 468-473. 10.1093/ageing/24.6.468.CrossRefPubMed Laukkanen P, Heikkinen E, Kauppinen M: Muscle strength and mobility as predictors of survival in 75–84-year-old people. Age Ageing. 1995, 24 (6): 468-473. 10.1093/ageing/24.6.468.CrossRefPubMed
21.
go back to reference Rantanen T, Era P, Heikkinen E: Maximal isometric strength and mobility among 75-year-old men and women. Age Ageing. 1994, 23 (2): 132-137. 10.1093/ageing/23.2.132.CrossRefPubMed Rantanen T, Era P, Heikkinen E: Maximal isometric strength and mobility among 75-year-old men and women. Age Ageing. 1994, 23 (2): 132-137. 10.1093/ageing/23.2.132.CrossRefPubMed
22.
go back to reference Gill TM, Allore HG, Gahbauer EA, Murphy TE: Change in disability after hospitalization or restricted activity in older persons. JAMA. 2010, 304 (17): 1919-1928. 10.1001/jama.2010.1568.CrossRefPubMedPubMedCentral Gill TM, Allore HG, Gahbauer EA, Murphy TE: Change in disability after hospitalization or restricted activity in older persons. JAMA. 2010, 304 (17): 1919-1928. 10.1001/jama.2010.1568.CrossRefPubMedPubMedCentral
23.
go back to reference Altman DG, Schulz KF, Moher D, Egger M, Davidoff F, Elbourne D, Gotzsche PC, Lang T, CONSORT GROUP (Consolidated Standards of Reporting Trials): The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Intern Med. 2001, 134 (8): 663-694.CrossRefPubMed Altman DG, Schulz KF, Moher D, Egger M, Davidoff F, Elbourne D, Gotzsche PC, Lang T, CONSORT GROUP (Consolidated Standards of Reporting Trials): The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Intern Med. 2001, 134 (8): 663-694.CrossRefPubMed
24.
go back to reference Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW: Studies of illness in the aged. The Index of ADL: a standardized measure of biological and psychosocial function. JAMA. 1963, 185: 914-919. 10.1001/jama.1963.03060120024016.CrossRefPubMed Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW: Studies of illness in the aged. The Index of ADL: a standardized measure of biological and psychosocial function. JAMA. 1963, 185: 914-919. 10.1001/jama.1963.03060120024016.CrossRefPubMed
25.
go back to reference Mahoney FI, Barthel DW: Functional evaluation: the Barthel index. Md State Med J. 1965, 14: 61-65.PubMed Mahoney FI, Barthel DW: Functional evaluation: the Barthel index. Md State Med J. 1965, 14: 61-65.PubMed
26.
go back to reference Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB: A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994, 49 (2): M85-M94.CrossRefPubMed Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB: A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994, 49 (2): M85-M94.CrossRefPubMed
27.
go back to reference Ostir GV, Volpato S, Fried LP, Chaves P, Guralnik JM, Women’s Health and Aging Study: Reliability and sensitivity to change assessed for a summary measure of lower body function: results from the Women’s Health and Aging Study. J Clin Epidemiol. 2002, 55 (9): 916-921. 10.1016/S0895-4356(02)00436-5.CrossRefPubMed Ostir GV, Volpato S, Fried LP, Chaves P, Guralnik JM, Women’s Health and Aging Study: Reliability and sensitivity to change assessed for a summary measure of lower body function: results from the Women’s Health and Aging Study. J Clin Epidemiol. 2002, 55 (9): 916-921. 10.1016/S0895-4356(02)00436-5.CrossRefPubMed
28.
29.
go back to reference Harper CM, Lyles YM: Physiology and complications of bed rest. J Am Geriatr Soc. 1988, 36 (11): 1047-1054.CrossRefPubMed Harper CM, Lyles YM: Physiology and complications of bed rest. J Am Geriatr Soc. 1988, 36 (11): 1047-1054.CrossRefPubMed
30.
go back to reference Olson EV, Johnson BJ, Thompson LF: The hazards of immobility. Am J Nurs. 1990, 90 (3): 43-48.PubMed Olson EV, Johnson BJ, Thompson LF: The hazards of immobility. Am J Nurs. 1990, 90 (3): 43-48.PubMed
31.
go back to reference Ward R, Tolas A, Benveniste R: Effect of posture on normal arterial blood gas tension in the aged. Geriatrics. 1966, 23: 139- Ward R, Tolas A, Benveniste R: Effect of posture on normal arterial blood gas tension in the aged. Geriatrics. 1966, 23: 139-
32.
go back to reference Collin C, Wade DT, Davies S, Horne V: The Barthel ADL index: a reliability study. Int Disabil Stud. 1988, 10 (2): 61-63. 10.3109/09638288809164103.CrossRefPubMed Collin C, Wade DT, Davies S, Horne V: The Barthel ADL index: a reliability study. Int Disabil Stud. 1988, 10 (2): 61-63. 10.3109/09638288809164103.CrossRefPubMed
33.
go back to reference Buchner DM, Hornbrook MC, Kutner NG, Tinetti ME, Ory MG, Mulrow CD, Schechtman KB, Gerety MB, Fiatarone MA, Wolf SL: Development of the common data base for the FICSIT trials. J Am Geriatr Soc. 1993, 41 (3): 297-308.CrossRefPubMed Buchner DM, Hornbrook MC, Kutner NG, Tinetti ME, Ory MG, Mulrow CD, Schechtman KB, Gerety MB, Fiatarone MA, Wolf SL: Development of the common data base for the FICSIT trials. J Am Geriatr Soc. 1993, 41 (3): 297-308.CrossRefPubMed
34.
go back to reference Kerse N, Peri K, Robinson E, Wilkinson T, von Randow M, Kiata L, Parsons J, Latham N, Parsons M, Willingale J, Brown P, Arroll B: Does a functional activity programme improve function, quality of life, and falls for residents in long term care? Cluster randomised controlled trial. BMJ. 2008, 337: a1445-10.1136/bmj.a1445.CrossRefPubMedPubMedCentral Kerse N, Peri K, Robinson E, Wilkinson T, von Randow M, Kiata L, Parsons J, Latham N, Parsons M, Willingale J, Brown P, Arroll B: Does a functional activity programme improve function, quality of life, and falls for residents in long term care? Cluster randomised controlled trial. BMJ. 2008, 337: a1445-10.1136/bmj.a1445.CrossRefPubMedPubMedCentral
35.
go back to reference Ruiz-Ruiz J, Mesa JL, Gutierrez A, Castillo MJ: Hand size influences optimal grip span in women but not in men. J Hand Surg Am. 2002, 27 (5): 897-901. 10.1053/jhsu.2002.34315.CrossRefPubMed Ruiz-Ruiz J, Mesa JL, Gutierrez A, Castillo MJ: Hand size influences optimal grip span in women but not in men. J Hand Surg Am. 2002, 27 (5): 897-901. 10.1053/jhsu.2002.34315.CrossRefPubMed
36.
go back to reference Folstein MF, Folstein SE, McHugh PR: Mini-Mental State. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975, 12 (3): 189-198. 10.1016/0022-3956(75)90026-6.CrossRefPubMed Folstein MF, Folstein SE, McHugh PR: Mini-Mental State. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975, 12 (3): 189-198. 10.1016/0022-3956(75)90026-6.CrossRefPubMed
37.
go back to reference Hollis S, Campbell F: What is meant by intention to treat analysis? Survey of published randomised controlled trials. BMJ. 1999, 319 (7211): 670-674. 10.1136/bmj.319.7211.670.CrossRefPubMedPubMedCentral Hollis S, Campbell F: What is meant by intention to treat analysis? Survey of published randomised controlled trials. BMJ. 1999, 319 (7211): 670-674. 10.1136/bmj.319.7211.670.CrossRefPubMedPubMedCentral
38.
go back to reference Holm S: A simple sequentially rejective multiple test procedure. Scand J Statist. 1979, 6: 65-70. Holm S: A simple sequentially rejective multiple test procedure. Scand J Statist. 1979, 6: 65-70.
Metadata
Title
Activity in GEriatric acute CARe (AGECAR): rationale, design and methods
Authors
Steven J Fleck
Natalia Bustamante-Ara
Javier Ortiz
María-Teresa Vidán
Alejandro Lucia
José A Serra-Rexach
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2012
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/1471-2318-12-28

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