Background: Physical activity is crucial for the health and well-being of older adults. This study aims to investigate physical activity goals, expectations, and barriers among older adult patients to improve interventions and health outcomes.
Methods: We conducted a mixed methods study at a large tertiary academic medical center from July to August 2024. We screened and invited hospitalized medical patients aged 62 years and older who had been admitted for at least two days to participate. We excluded patients who had significant cognitive impairment. Using a standard questionnaire, we interviewed participants about their prior level of function using the Katz Index of Independence in Activities of Daily Living (ADL), and physical activity expectations, preferences, and barriers while hospitalized. Statistical analysis included descriptive statistics using measures of central tendency and distribution.
Results: Of 81 screened and invited patients, 70 (86.4%) agreed and were interviewed. Median age was 74 years (IQR, 69-77) and 51%, were female. Most participants were White (77.1%), followed by Black (12.9%) and other/unknown races (10.0%). Median BMI was 28.8 kg/m² (IQR, 24.2-32.6 kg/m²), with 40.6% obese and 26.1% overweight. A majority (81.4%) had Charlson Comorbidity Score >3, median was 7 (IQR, 4-9). Depression (38.6%) and neurological disorders (20.0%) were common comorbid conditions. Nearly all patients were placed under fall precautions (98.6%), despite only 7.1% having a history of falls. A substantial number received psychotherapeutic drugs (50.0%) and opiates (72.9%). Median Katz ADL Index was 5 (IQR, 5-5), indicating prior level of function of mostly independent with assistance required in one ADL. Median initial Activity Measure for Post-Acute Care (AM-PAC) “6-Clicks” score was 18 (IQR, 14-21) and John Hopkins Highest Level of Mobility (JH-HLM) was 6, which reflects ability to walk 10 steps or more, (IQR, 3-7). All patients had completed an initial JH-HLM assessment. Physical and occupational therapy evaluations were completed on 70.0% and 51.4% of cases. Most participants expected to be less active than usual during hospitalization (67.1%), though they preferred to maintain or increase their pre-hospitalization activity levels (81.5%). Key barriers were lack of energy (31.4%), poor health (27.1%), and need for rest (17.1%). Other barriers included fear of injury, lack of time, and pain.
Conclusions: Despite high comorbidity prevalence and nearly universal implementation of fall precautions, many older adult patients preferred to maintain or increase activity levels during hospitalization. Key barriers included lack of energy, poor health, and need for rest. These findings highlight the need for targeted interventions to overcome biopsychosocial barriers and enhance physical activity among hospitalized older adults.