Nursing care for hospitalized older adults - fall accidents versus safe mobility: a scoping review

Nicoli, Esther Mourão; Silva, Frances Valéria Costa e; Assad, Luciana Guimarães; Cardinelli, Camila Castanho; Alves, Raquel Azevedo; Oliveira, Samara Gonçalves de

doi:10.1590/0034-7167-2023-0180

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Revista Brasileira de Enfermagem

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Sumário

REVIEW • Rev. Bras. Enferm. 77 (2) • 2024 • https://doi.org/10.1590/0034-7167-2023-0180 copy

Nursing care for hospitalized older adults - fall accidents versus safe mobility: a scoping review

Atención de enfermería a personas mayores hospitalizadas: accidentes de caída versus movilidad segura: revisión del alcance

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

to map the constituent elements of the safe mobility concept present in hospital care for older adults.

Methods:

a scoping review of 35 articles searched in databases and gray literature - BDENF/VHL, Scopus, CINAHL/EBSCO, Embase, Web of Science, PEDro, MEDLINE/PubMed and CAPES Theses and Dissertations Catalog. No time or language cut-off was established.

Results:

none of the studies presented a clear safe mobility concept, however its constituent elements involve factors related to patient (behavioral factors, conditions, diseases, signs and symptoms, nutritional status, age, balance, strength, gait quality, sleep), the institution (environment, treatment devices, guidelines, medications and polypharmacy, material and human resources and clothing/shoes) and the nature of the interventions (related to the patient, institution and family).

Final Considerations:

the constituent elements of safe mobility express hospital units’ capacity to guarantee care and protection from fall accidents for hospitalized older adults.

Descriptors:
Accidental Falls; Nursing Care; Mobility Limitation; Aged; Hospitals

Article title		Year Country	Design Sample	Objective	Results
1	Immobility and falls(¹⁶16 Mahoney JE. Immobility and falls. Clin Geriatr Med [Internet]. 1998 [cited 2023 Jun 2]; 14(suppl 4):699-726. Available from: https://pubmed.ncbi.nlm.nih.gov/9799475/ https://pubmed.ncbi.nlm.nih.gov/9799475/... )	1998 USA	Theoretical-conceptual	Not specified	Appropriate actions to prevent immobility and falls include increasing exercise and activity levels, improving the hospital environment, and decreasing the use of psychotropic medications. Bed alarms and increased supervision for high-risk patients can also help prevent falls.
2	Technology to promote safe mobility in the elderly(¹⁷17 Nelson A, Powell-Cope G, Gavin-Dreschnack D, Quigley P, Bulat T, Baptiste AS et al. Technology to promote safe mobility in the elderly. Nurs Clin North Am. 2004; 39(suppl 3):649-71. https://doi.org/10.1016/j.cnur.2004.05.001 https://doi.org/10.1016/j.cnur.2004.05.0... )	2004 USA	Theoretical-conceptual	To describe new technologies designed to help prevent adverse events in the functional domain of mobility.	Key technologies to prevent falls and fall-related injuries include hipprotectors, wheelchair/scooter safety features, intelligent walkers, fall alarms, and environmental aids.
3	Why do we use physical restraints in the elderly?(¹⁸18 Hamers JPH, Huizing AR. Why do we use physical restraints in the elderly? Z Gerontol Geriatr. 2005; 38(suppl 1):19-25. https://doi.org/10.1007/s00391-005-0286-x https://doi.org/10.1007/s00391-005-0286-... )	2005 Netherlands	Literature review (type of review and sample size not specified)	Answer the question “Why do we use physical restraints in older adults?”, summarizing current knowledge about the use of restraints in older adults.	With regard to prevention of falls, numerous interventions have been suggested in the literature, like floor mats, hip protectors, position alarms, motion devices, anti-slip mats, height adjustable beds, bed next to wall and multi-factorial falls risk assessment and management programs.
4	Barriers to mobility during hospitalization from the perspective of the elderly and their nurses and doctors(¹⁹19 Brown CJ, Williams BR, Woodby LL, Davis LL, Allman RM. Barriers to mobility during hospitalization from the perspective of the elderly and their nurses and doctors. J Hosp Med. 2007; 2(suppl 5):305-13. https://doi.org/10.1002/jhm.209 https://doi.org/10.1002/jhm.209... )	2007 USA	Qualitative interviews analyzed and interpreted using a grounded theory approach. 29 participants - 10 patients > or = 75 years old, 10 nurses and 9 resident doctors	To identify barriers to mobility during hospitalization from the perspectives of older adult patients and their primary nurses and physicians, to compare and contrast the perceived barriers between these groups, and to build a conceptual model.	Content analysis identified 31 perceived barriers to increasing mobility during hospitalization. The barriers most frequently described by the three groups were symptoms (97%), especially weakness (59%), pain (55%) and fatigue (34%); have intravenous access (69%) or urinary catheter (59%); and concern about falls (79%). The lack of staff to assist with activities outside the bed was mentioned by patients (20%), nurses (70%) and doctors (67%).
5	Der Sturz im Krankenhaus: Ein Qualitätsindikator?⁽ ²⁰⁾	2007 Germany	Primary research. 811 “fallers” (total number of falls: 1,177) and 5,229 “non-fallers” in a geriatric hospital.	To answer the question “Are falls associated with a result of lower mobility (Barthel Index) at discharge?”.	A higher rate of falls was associated with a better outcome in two of the three mobility-related items of the Barthel Index (transfer, walk/wheelchair).
6	An elderly-centered, personalized, physiotherapy program early after cardiac surgery(²¹21 Opasich C, Patrignani A, Mazza A, Gualco A, Cobelli F, Domenico PG. An elderly-centered, personalized, physiotherapy program early after cardiac surgery. Eur J Cardiovasc Prev Rehabi. 2010; 17(suppl 5):582-7. https://doi.org/10.1097/HJR.0b013e3283394977 https://doi.org/10.1097/HJR.0b013e328339... )	2010 Italy	Primary research. 224 consecutive patients aged 70 to 87 years followed the personalized (n = 150) or usual (n = 74) program	1) To validate our approach to personalizing the physiotherapy program by assessing the relationship between the level of frailty and patients’ functional impairment, disability and postoperative evolution; 2) To assess the effect of the personalized program on independence and mobility and compare this effect with that of our traditional training program.	At discharge, both groups had significantly improved on all measures of independence and mobility, but most of these changes (nursing needs, mobility, balance, and muscle strength) were significantly greater (P < 0.05) in the intervention group. These patients also had a significantly shorter length of stay (17.5 ± 8 vs. 21 ± 4 days, P = 0.0002), and 91% of them could be discharged in a state of substantial independence.
7	Improving care for patients with dementia hospitalized for acute somatic illness in a specialized care unit: a feasibility study(²²22 Zieschang T, Dutzi I, Müller E, Hestermann U, Grünendahl K, Braun AK et al. Improving care for patients with dementia hospitalized foracute somatic illness in a specialized care unit: a feasibility study. Int Psychogeriatr. 2010; 22(suppl 1):139-46. https://doi.org/10.1017/S1041610209990494 https://doi.org/10.1017/S104161020999049... )	2010 Germany	Primary research. 332 consecutively admitted patients were enrolled	To develop a segregated Special Care Unit (SCU) in a somatic hospital for patients with challenging behavior resulting from dementia and/or delirium. This pilot study assesses feasibility and patient outcomes.	Six patients were transferred to geriatric psychiatry. Two patients suffered a fall-related hip fracture. The median Barthel Index improved significantly (admission 30, discharge 45, p < 0.001), with only 8.5% of patients suffering functional loss. Wandering, aggression and agitation were significantly reduced (p < 0.001).
8	Nutritional status and associations with falls, balance, mobility and functionality during hospital admission(²³23 Vivanti A, Ward N, Haines T. Nutritional status and associations with falls, balance, mobility and functionality during hospital admission. J Nutr Health Aging. 2011; 15(suppl 5):388-91. https://doi.org/10.1007/s12603-010-0302-8 https://doi.org/10.1007/s12603-010-0302-... )	2011 Australia	Observational longitudinal cohort study. Admissions to the Geriatric Assessment and Rehabilitation Unit over a period of six months were included.	To explore the associations between nutritional status, falls and selected risk factors among hospitalized older adults.	Patients assessed as malnourished were older (p<0.001) and more likely to have a poorer score on both the admission (p<0.05) and discharge (p<0.009) timed “Up and Go” test. Malnutrition was associated with reduced mobility (p<0.05).
9	Ten Ways to Improve the Care of Elderly Patients in the Hospital(²⁴24 Labella AM, Merel SE, Phelan EA. Ten Ways to Improve the Care of Elderly Patients in the Hospital. J Hosp Med. 2011; 6(suppl 6):351-7. https://doi.org/10.1002/jhm.900 https://doi.org/10.1002/jhm.900... )	2011 USA	Theoretical-conceptual	Not specified	Ways to improve care for hospitalized older adults include: screening for geriatric syndromes such as delirium, assessing functional status and maintaining mobility, and implementing interventions that have been proven to prevent delirium, accidental falls and acute functional decline in the hospital.
10	A randomized controlled trial to prevent hospital readmissions and loss of functional ability in high risk older adults: a study protocol(²⁵25 Courtney MD, Edwards HE, Chang AM, Parker AW, Finlayson K, Hamilton K. A randomized controlled trial to prevent hospital readmissions and loss of functional ability in high risk older adults: a study protocol. BMC Health Serv Res. 2011; 11(suppl 202):1-7. https://doi.org/10.1186/1472-6963-11-202 https://doi.org/10.1186/1472-6963-11-202... )	2011 Australia	Randomized controlled trial. 328 participants (82/group)	To assess innovative transitional care strategies to reduce unplanned readmissions and improve functional status, independence, and psychosocial well-being of community-dwelling older adults at risk of readmission.	Individualized exercise programs designed to improve strength, stability, coordination, endurance, mobility, and improve self-confidence with respect to activities of daily living. The exercise prescription will be developed using a team approach involving patients, caregivers, doctors, and ward nurses.
11	Predicting Habitual Physical Activity Using Coping Strategies in Older Fallers Engaged in Falls-Prevention Exercise(²⁶26 Laybourne AH, Biggs S, Martin FC. Predicting Habitual Physical Activity Using Coping Strategies in Older Fallers Engaged in Falls-Prevention Exercise. J Aging Phys Act. 2011; 19(suppl 3):189-200. https://doi.org/10.1123/japa.19.3.189 https://doi.org/10.1123/japa.19.3.189... )	2011 England	Observational study. 98 men and women	To examine physical activity in older adults who fall, applying an adaptation theory, to determine predictors of habitual physical activity.	Two coping strategies, loss-based selection and optimization, best explained the change in physical activity between baseline and follow-up.
12	Improving physical activity in older adults receiving in patient rehabilitation: a phase II feasibility study(²⁷27 Said CM, Morris ME, Woodward M, Churilov L, Bernhardt J. Improving physical activity in older adults receiving inpatient rehabilitation: a phase II feasibility study. BMC Geriatr. 2012; 12(suppl 26)1-8. https://doi.org/10.1186/1471-2318-12-26 https://doi.org/10.1186/1471-2318-12-26... )	2012 Australia	Single-blind, randomized clinical trial (RCT) with intention-to-treat analysis 47 participants randomized to a control group (25) or intervention group (22)	To assess the feasibility of an RCT of increasing physical activity in older adults undergoing rehabilitation.	The proposed RCT of enhanced physical activity in older adults receiving rehabilitation was feasible.
13	Vestibular and Motor Contributions to Mobility: Limitations of Seniors Awaiting Discharge from Hospital Care(²⁸28 Golder MD, Earl EM, Mallery LH. Vestibular and Motor Contributions to Mobility: Limitations of Seniors Awaiting Discharge from Hospital Care. Physiother Res Int. 2012;17(suppl 4):200-7. Disponível em: https://doi.org/10.1002/pri.532 https://doi.org/10.1002/pri.532... )	2012 Canada	Experimental and correlation designs	The main objective of this article was to assess the ability of hospitalized older adults to use vestibular information to control balance. The secondary objective was to examine the influence of vestibular function and lower limb muscle strength on mobility.	Seniors awaiting discharge from hospital had impaired vestibular control of balance that was systematically associated with impaired mobility. Assessing vestibular function prior to discharge from hospital could improve discharge planning with respect to management of impairments that threaten balance and safe mobility.
14	Measure, Promote and Reward Mobility to Prevent Falls in Older Patients(²⁹29 Sinha SK, Detsky AS. Measure, Promote and Reward Mobility to Prevent Falls in Older Patients. JAMA. 2012; 308(suppl 24):2573-4. https://doi.org/10.1001/jama.2012.68313 https://doi.org/10.1001/jama.2012.68313... )	2012	Theoretical-conceptual	Not specified	A focus on maintaining and improving mobility should been couraged when an older adult becomes acutely ill and particularly vulnerable to permanently losing functional capacity during a hospitalization. More importandy, encouraging routine strength and balance training in community-dwelling older adults should be a priority.
15	What is the involvement of the nursing team in maintaining and promoting the mobility of the elderly in the hospital? A grounded theory study(³⁰30 Kneafsey R, Clifford C, Greenfield S. What is the involvement of the nursing team in maintaining and promoting the mobility of the elderly in the hospital? A grounded theory study. Int J Nurs Stud. 2013; 50(suppl 12):1617-29. https://doi.org/10.1016/j.ijnurstu.2013.04.007 https://doi.org/10.1016/j.ijnurstu.2013.... )	2013 England	Semi-structured interviews with 39 rehabilitation professionals and 61 hours of non-participant observation comprised the dataset	To present a grounded theory on the nursing team involvement in the process of maintaining and promoting the mobility of hospitalized older adults.	The nursing team involvement in maintaining and rehabilitating patients’ mobility was explained by the central category “care to maintain safety”. It identified how the nursing team focused primarily on preventing patient problems rather than focusing on rehabilitation goals. A number of contextual factors in the workplace meant that nursing staff had difficulty engaging in activities to support mobility maintenance and rehabilitation.
16	Activity restriction vs self-direction: hospitalised older adults’ response to fear of falling(³¹31 Boltz M, Resnick B, Capezuti E, Shuluk J. Activity restriction vs. self-direction: hospitalised older adults’ response to fear of falling. Int J Older People Nurs. 2014; 9(suppl 1):44-53. https://doi.org/10.1111/opn.12015 https://doi.org/10.1111/opn.12015... )	2014 USA	Quantitative and qualitative approach combined with medical records extraction. 41 older adults	To describe the fear of falling in hospitalized older adults and its relationship with patients’ characteristics and physical function and explore patients’ view of associated factors.	Participants described the following factors, organised by social-ecological framework, to be considered when developing alternatives to activity restriction: intrapersonal, interpersonal, environmental and policy.
17	Implementing a Comprehensive Functional Model of Care in Hospitalized Older Adults(³²32 Lyons DL. Implementing a Comprehensive Functional Model of Care in Hospitalized Older Adults. Medsurg Nurse [Internet]. 2014 [cited 2023 Jan 6]; 23(6):379-85. Available from: https://pubmed.ncbi.nlm.nih.gov/26281632/ https://pubmed.ncbi.nlm.nih.gov/26281632... )	2014 USA	Convenience sample. 866 older adults	To develop a comprehensive model of care to promote physical function in hospitalized older adults.	Implementing a comprehensive functional model of care for hospitalized older adults had a positive impact on length of stay, 30-day readmission rate, and fall rate. The estimated cost savings associated with reducing post-intervention length of stay by 3 months was approximately $200.00.
18	Diagnósticos e prescrições de enfermagem para idosos em situação hospitalar (³³33 Lira LN, Santos SSC, Vidal DAS, Gautério DP, Tomaschewski-Barlem JG, Piexak DR. Diagnósticos e prescrições de enfermagem para idosos em situação hospitalar. Av Enferm. 2015;33(suppl 2):251-60. https://doi.org/10.15446/av.enferm.v33n2.30762 https://doi.org/10.15446/av.enferm.v33n2... )	2015 Brazil	Qualitative research submitted to descriptive statistical analysis. 50 older adults	To identify the most frequent nursing diagnoses described by the North American Nursing Diagnosis Association among older adults in a hospital situation and propose related prescriptions for older adults in a hospital situation.	Of the older adults surveyed, 36 (72%) were diagnosed with risk of falls, manifested by the need for assistance with walking and gait disturbance. Research carried out by nurses from Minas Gerais assessed the risk factors presented for the risk for falls nursing diagnosis, observing the predominance of intrinsic factors over extrinsic ones. The most common intrinsic factors were age over 65 years (84%), use of medications (28%), difficulty walking (22%) and history of falls (22%).
19	Effectiveness of an individualized fall prevention program in a geriatric rehabilitation hospital setting: a cluster randomized study(³⁴34 Aizen E, Lutsyk G, Wainer L, Carmeli S. Effectiveness of an individualized fall prevention program in a geriatric rehabilitation hospital setting: a cluster randomized study. Aging Clin Exp Res. 2015;27(suppl 5):681-8. https://doi.org/10.1007/s40520-015-0330-7 https://doi.org/10.1007/s40520-015-0330-... )	2015 Israel	Two-stage cluster-controlled trial conducted in five geriatric rehabilitation wards. 752 patients	To investigate the effect of an individualized fall prevention program in a geriatric rehabilitation hospital.	Although falls may occasionally have one simple explanation, they are generally the result of synergistic interactions between frailties, long-termmedical illness, acute medical illness, medications, the person’s own behavior and environmental hazards.
20	Moving forward in fall prevention: an intervention to improve balance among patients in a quasi-experimental study of hospitalized patients(³⁵35 Villafañe JH, Pirali C, Buraschi R, Arienti C, Corbellini C, Negrini S. Moving forward in fall prevention: an intervention to improve balance among patients in a quasi-experimental study of hospitalized patients. Int J Rehabil Res. 2015;38(suppl 4):313-9. https://doi.org/10.1097/MRR.0000000000000128 https://doi.org/10.1097/MRR.000000000000... )	2015 Italy	Prospective quasi-experimental study. 28 patients	To investigate whether three different rehabilitation programs, such as group exercises, individual core stability or balance training intervention with a stabilometric platform, were effective in improving balance capacity in hospitalized older adult patients and evaluate whether there were differences in terms of effectiveness between these three different programs.	Participation in an exercise program can improve balance and functional mobility, which might contribute toward the reductions of falls of older adults hospitalized and the subsequent fall-related costs.
21	Instrumento de avaliação de quedas em idosos hospitalizados (IAQI Hospitalar): enfermeiro analisando vulnerabilidade e mobilidade (³⁶36 Oliveira DM, Hammerschmidt, KSA, Schoeller SD, Girondi JBR, Bertoncello KCG, Paula Junior NF. Instrumento de avaliação de quedas em idosos hospitalizados (IAQI Hospitalar): enfermeiro analisando vulnerabilidade e mobilidade. Rev Enferm UFPE [Internet]. 2016[cited 2023 Jun 2];10(suppl 11):4065-74. Available from: https://pesquisa.bvsalud.org/portal/resource/pt/bde-30154 https://pesquisa.bvsalud.org/portal/reso... )	2016 Brazil	Exploratory and descriptive study, with a qualitative approach	To develop an instrument to assess vulnerability to falls in hospitalized older adults.	IAQI Hospitalar helps determine the individual profile and vulnerability of older adults so that fall prevention actions can be scheduled.
22	Comparison of posthospitalization function and community mobility in hospital mobility program and usual care patients: a randomized clinical trial(³⁷37 Brown CJ, Foley KT, Lowman Junior JD, MacLennan PA, Razjouyan J, Najafi B, et al. Comparison of post-hospitalization function and community mobility in hospital mobility program and usual care patients: a randomized clinical trial. JAMA Intern Med. 2016;176(suppl 7):921-7. https://doi.org/10.1001/jamainternmed.2016.1870 https://doi.org/10.1001/jamainternmed.20... )	2016 USA	Single-blind randomized clinical trial. 100 patients	To examine the effect of an in-hospital mobility program (MP) on post-hospitalization function and community mobility.	The MP intervention allowed patients to maintain pre-hospitalization community mobility, while those in the usual care group experienced clinically significant declines. Lower living space mobility is associated with increased risk of death, nursing home admission, and functional decline, suggesting that declines such as those observed in the usual care group would be of great clinical importance.
23	The effects of a high-intensity functional exercise group on clinical outcomes in hospitalised older adults: an assessor-blinded, randomised- controlled trial(³⁸38 Raymond MJM, Jeffs KJ, Winter A, Szeee S, Hunter P, Holland AE. The effects of a high-intensity functional exercise group on clinical outcomes in hospitalised older adults: an assessor-blinded, randomised-controlled trial. Age Ageing. 2017;46(suppl 2)208-13. https://doi.org/10.1093/ageing/afw215 https://doi.org/10.1093/ageing/afw215... )	2017 Australia	Single-blind, randomized and controlled trial. 468 patients	To investigate a high-intensity functional exercises (HIFE) group in hospitalized older adults.	The results suggest that a HIFE group programme combined with individual physiotherapy may improve mobility to a similar extent to individual physiotherapy alone in hospitalised older adults. Providing physiotherapy in a group setting resulted in increased therapist efficiency. A high-intensity exercise group with individual physiotherapy may be aneffective and efficient method to provide care to older inpatients.
24	The Case for Mobility Assessment in Hospitalized Older Adults: American Geriatrics Society White Paper Executive Summary(⁴4 Wald HL, Ramaswamy R, Perskin MH, Roberts L, Bogaisky M, Suen W, et al. The case for mobility assessment in hospitalized older adults: American Geriatrics Society white paper executive summary. J Am Geriatr Soc. 2019;67(suppl-1):11-16. https://doi.org/10.1111/jgs.15595 https://doi.org/10.1111/jgs.15595... )	2018 USA	White paper supporting a greater focus on mobility as an outcome for hospitalized older adults	To assess and prevent loss of mobility in hospitalized older adults and summarize the recommendations in this white paper.	Recommendations: 1) Promote mobility assessment inacute care; 2) Advocate for more research funding; 3) Develop consensus on standardmethods to assess mobility; 4) Minimize the burden of mobility measurement; 5) Assess the feasibility of a mobility quality measure; 6) Reframe the current regulatory focus on falls in acute care to a focus on safe mobility; 7) Develop resources for acute caregivers.
25	Muscle strength is longitudinally associated with mobility in the elderly after acute hospitalization: the Hospital-ADL study(³⁹39 Aarden JJ, van der Schaaf M, van der Esch M, Reichardt LA, van Seben R, Bosch JA, et al. Muscle strength is longitudinally associated with mobility in the elderly after acute hospitalization: the Hospital-ADL study. PLoS One. 2019;14(suppl 7):e0219041. https://doi.org/10.1371/journal.pone.0219041 https://doi.org/10.1371/journal.pone.021... )	2019 Netherlands	Multicenter, prospective, observational cohort study. 391 older adults	To determine (i) the course of mobility of older adults hospitalized in an acute situation and (ii) the association between muscle strength and the course of mobility over time controlled by influencing factors.	Muscle strength is longitudinally associated with mobility. Interventions to improve mobility including muscle strength are warranted in acute hospitalized older adults.
26	An augmented prescribed exercise program (APEP) to improve mobility in older acute medical patients - a randomized controlled pilot and feasibility study(⁴⁰40 Braun T, Grüneberg C, Süßmilch K, Wiessmeier M, Schwenk I, Eggert S et al. An augmented prescribed exercise program (PAEP) to improve mobility in older acute medical patients: a randomized controlled pilot and feasibility study. BMC Geriatr. 2019;19(suppl 1):240. https://doi.org/10.1186/s12877-019-1246-4 https://doi.org/10.1186/s12877-019-1246-... )	2019 Germany	Single-center, prospective, parallel-group, blinded, randomized (1:1) controlled pilot and feasibility study. 35 participants	To assess the feasibility of an Augmented Prescription Exercise Program (APEP) in older acute medical patients and to measure the potential effects of APEP on mobility capacity in order to assess the feasibility of a large-scale study.	This small feasibility RCT indicates that an APEP intervention may be safe and feasible in older acute medical patients. APEP may possibly induce small to moderate effects on mobility, but the clinical relevance of these effects may be limited.
27	Optimizing Function and Physical Activity in Hospitalized Older Adults to Prevent Functional Decline and Falls(⁴¹41 Resnick B, Boltz M. Optimizing Function and Physical Activity in Hospitalized Older Adults to Prevent Functional Decline and Falls. Geriatr Med. 2019; 35(suppl 2):237-51. https://doi.org/10.1016/j.cger.2019.01.003 https://doi.org/10.1016/j.cger.2019.01.0... )	2019 USA	Theoretical-conceptual	Not specified.	Increasing physical activity of patients and decreasing falls is critically important tooptimize outcomes for patients and decrease length of hospital stays. There is no single approach that will effectively assure optimal time spent in physical activityor that a fall will not occur. Multifactorial approaches are needed that focus on in-dividual risks and challenges within each individual.
28	Predictors of physical activity in older adults at the start of an emergency hospital stay: a prospective cohort study(⁴²42 Hartley P, DeWitt AL, Forsyth F, Romero-Ortuno R, Deaton C. Predictors of physical activity in older adults at the start of an emergency hospital stay: a prospective cohort study. BMC Geriatr. 2020; 20(suppl 1):177. https://doi.org/10.1186/s12877-020-01562-3 https://doi.org/10.1186/s12877-020-01562... )	2020 United Kingdom	Secondary analysis of a prospective repeated measures cohort study. 62 participants	To investigate predictors of in-hospital activity during a 24-hour period in the first 48 hours of hospital admission in older adults.	Physical activity, particularly in the acute phase of hospitalisation, is very low in older adults. The association between illness severity and physical activity may be explained by symptoms of acute illness being barriers to activity.
29	Promoting mobility among hospitalized elderly: an exploratory study on the perceptions of patients, caregivers and nurses(⁴³43 Lim SH, Ang SY, Ong HK, Lee TZY, Lee TXL, Luo EZ et al. Promoting mobility among hospitalized elderly: an exploratory study on the perceptions of patients, caregivers and nurses. Geriatr Nurs. 2020;41(suppl 5):608-614. https://doi.org/10.1016/j.gerinurse.2020.03.015 https://doi.org/10.1016/j.gerinurse.2020... )	2020 Singapore	Descriptive qualitative study with a purposeful and convenience sampling approach. 14 patients, six caregivers and ten nurses	To explore the perceptions of patients and their caregivers as well as nurses on promoting mobility among hospitalized older adult patients.	Recognition of the importance of mobility as well as the detrimental effects of prolonged bed rest during hospitalization is an essential first step toward developing successful interventions to promote mobility in the Asian context. Improvements need to be made to help overcome the various barriers and challenges in the mobilization of older patients in acute care settings. Nurses and other care team members can help to increase the confidence of patients and among family caregivers (in providing assistance during mobility) by role modelling and provision of walking aids as well as risk-based education.
30	Factors associated with walking in hospitalized elderly(⁴⁴44 McCullagh R, Darren D, Horgan NF, Timmons S. Factors associated with walking in hospitalized elderly. Arch Rehabil Res Clin Transl. 2020; 2(suppl-1):100038. https://doi.org/10.1016/j.arrct.2020.100038 https://doi.org/10.1016/j.arrct.2020.100... )	2020 Ireland	Cohort study. 154 participants	To identify patient characteristics upon admission and daily events during hospitalization that could influence the walking activity of older adult patients during hospitalization.	Daily step count fluctuated, suggesting considerable scope for intervention. Devices or treatments that hinder walking should be reviewed daily and walking activity should become a clinical priority. Admission physical performance may identify vulnerable patients.
31	Assisted Walking Program on Walking Ability in In-Hospital Geriatric Patients: A Randomized Trial(⁴⁵45 Gazineo S, Godino L, Decaro R, Calogero P, Pinto D, Chiari P, et al. Assisted Walking Program on Walking Ability in In-Hospital Geriatric Patients: A Randomized Trial. J Am Geriatr Soc. 2021; 69(suppl 3):637-643. https://doi.org/10.1111/jgs.16922. https://doi.org/10.1111/jgs.16922... )	2021 Italy	RCT. 387 patients	To assess whether an individualized assisted walking program for hospitalized older adult patients could improve walking capacity compared to usual geriatric care and rehabilitation.	Baseline characteristics were similar between intervention and control groups. The intervention group, relative to the control group, had significantly improved walking ability at discharge (P < .001). There were no statistically significant differences between the groups in terms of in-hospital adverse events. No adverse effects were detected.
32	Reimagining Injurious Falls and Safe Mobility(²2 Hendrich A. Reimagining injurious falls and safe mobility. Am J Nurs. 2021;121(suppl 9):34-44. https://doi.org/10.1097/01.NAJ.0000790188.10474.10 https://doi.org/10.1097/01.NAJ.000079018... )	2021 USA	Theoretical-conceptual	To propose a new approach to reducing falls with injuries in older adults based on evidence-based protocols known to positively impact older adults’ health.	ERA - Electronic health record integration, Risk factors that matter, Assessment and care plans - allows nurses to use a validated fall risk assessment tool to reframe fall risk factors as part of a comprehensive care plan, and to map modifiable risk factors to interventions that address the underlying causes of falls and promote safer mobility. The ERA approach can help nurses use their time more effectively by focusing on targeted actions that improve patient outcomes, working in coordination with an interprofessional, cross-continuum care team.
33	Effects of General Physical Activity Promoting Interventions on Functional Outcomes in Patients Hospitalized over 48 Hours: A Systematic Review and Meta-Analysis of Randomized Controlled Trials(⁴⁶46 Seeger JPH; Koenders N, Steel JB, Hoogeboom TJ. Effects of general physical activity promoting interventions on functional outcomes in patients hospitalized over 48 hours: a systematic review and meta-analysis of randomized controlled trials. Int J Environ Res Public Health. 2021; 18(suppl 3):1233. https://doi.org/10.3390/ijerph18031233. https://doi.org/10.3390/ijerph18031233... )	2021 Netherlands	Systematic review study: five electronic databases were searched for RCT. For results reported in two or more studies, meta-analysis was performed to test differences between groups	To assess the effect of general physical activity, promoting interventions on functional and hospital outcomes in patients hospitalized for more than 48 hours.	Overall, we found no conclusive evidence on the effect of general physical activity promoting interventions on functional outcomes.
34	Pilot testing of nurse led multimodal intervention for falls prevention(⁴⁷47 Cerilo PC, Siegmund LA. Pilot testing of nurse led multimodal intervention for falls prevention. Geriatr Nurs. 2022;43:242-8. https://doi.org/10.1016/j.gerinurse.2021.12.002 https://doi.org/10.1016/j.gerinurse.2021... )	2022 USA	Preand post-test pilot study in a single group. 70 patients	To examine the effect of a nurse-led multimodal intervention on levels of fall risk awareness, self-efficacy, and involvement in fall prevention among hospitalized adults.	There were significant differences [pre-test (M= 19.02, SD=1.152) and post-test (M= 21.71, SD=0.527); t (17.355) = 58,p.001] on level of fall risk awareness in fall prevention. There were no significantfindings for fall self-efficacy and engagement. Study findings suggested that the higher the fall self-efficacy, the higher the engagement. Future research is needed to examine self-efficacy and engagement for fall prevention in larger diverse cohorts of hospitalized older adults.
35	Effect of a Ward-Based Program on Hospital-Associated Complications and Length of Stay for Older Inpatients The Cluster Randomized CHERISH Trial(⁴⁸48 Mudge AM, McRae P, Banks M, Blackberry I, Barrimore S, Endacott J. Effect of a ward-based program on hospital-associated complications and length of stay for older inpatients: the Cluster Randomized CHERISH Trial. JAMA Intern Med. 2022; 182(suppl 3):274-282. https://doi.org/10.1001/jamainternmed.2021.7556 https://doi.org/10.1001/jamainternmed.20... )	2022 Australia	Pragmatic cluster randomized trial. 539 patients	To implement and assess a ward-based improvement program (“Eat Walk Engage”) to more consistently provide older adult-friendly principles of care to older adults in acute patient ward situations.	Eat Walk Engage did not reduce the composite primary outcome of any HAC-OP, which affected almost half of older inpatients, although there was a significant reduction in delirium.

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[1] Corresponding author: Esther Mourão Nicoli, E-mail: esther.mnicoli@gmail.com