Mobilization of Ventilated Older Adults

Davis, Josaleen MD; Crawford, Kelley DPT; Wierman, Heidi MD; Osgood, Wendy MSB, PT; Cavanaugh, James PhD, PT; Smith, Kahsi A. PhD; Mette, Stephen MD; Orff, Sonja RN, CNL

Journal of Geriatric Physical Therapy: October/December 2013 - Volume 36 - Issue 4 - p 162–168
doi: 10.1519/JPT.0b013e31828836e7
Research Reports

Background: Recent studies of ventilated, critically ill patients have shown early mobilization to be safe and resulting in better functional outcomes at discharge but have not focused on older adults.

Objectives: The objectives of this pilot study were to examine the feasibility of and to describe functional outcomes associated with providing early mobilization to critically ill, older adult patients.

Methods: This is a prospective cohort study that took place in the medical and surgical intensive care units of a tertiary, academic medical center. Participants were aged 65 years or older, were on mechanical ventilation for 72 or more hours, and had a preadmission Barthel Index score of 70 or greater. Patients with an open ventriculostomy, continuous hemodialysis, or hospitalization of 7 or more days prior to intubation were excluded. A standardized early mobilization protocol was applied by a trained physical and occupational therapist to eligible participants according to previously published guidelines. Demographic information, hospitalization data, RAND 36-Item Short Form Health Survey (SF-36), and Barthel Index scores from preadmission, hospital discharge, and 30-day follow-up were collected.

Results: Patients who survived to hospital discharge compared with nonsurvivors were similar in their admission and hospital stay demographics. Survivors reported significantly higher functioning than nonsurvivors on preadmission functional status on both the physical functioning and general health RAND SF-36 subscales. Nonsurvivors reported significantly lower physical functioning, general health, vitality, and mental health on preadmission function when compared with the published normative RAND SF-36 data for patients aged 75 years and older. Patients who did survive hospitalization reported significantly more bodily pain at 30-day follow-up than the published normative data. Patients met criteria for therapy 92% of planned interventions, 99% of those sessions were completed, and adverse events occurred in less than 1% of interventions.

Conclusion: Overall results indicate the feasibility and safety of implementing an early mobilization program to critically ill older adult patients.

1Maine Medical Center, Portland, Maine.

2University of New England Department of Physical Therapy, University of New England, Biddeford, Maine.

3Allina Health Systems, Minneapolis, Minnesota.

Address correspondence to: Josaleen Davis, MD, Department of Geriatrics, Maine Medical Center, Allina Health Systems, 1055 Westgate Dr. Ste 100, St. Paul, MN 55114 (josaleen.davis@allina.com).

This research was supported by a grant from the Maine Medical Mentored Research Committee. The funding source had no role in conduction of the study, interpretation of data, analysis, or development of manuscript. The investigators retained full independence in conduction of this research.

The authors declare no conflicts of interest.

© 2013 Academy of Geriatric Physical Therapy, APTA