Regardless of why an older person is admitted to hospital, their ability to move and care for themselves will determine the care and services they will need while in hospital and after discharge.
Older people in hospital are at risk of functional decline and de-conditioning as early as two days after admission1. As clinicians, we should encourage older people to maintain or improve their mobility and self-care skills participating in activities.
This topic gives an overview of the importance of mobility and self-care, tools to identify issues, and strategies to improve an older person’s mobility and self-care. In addition to following health service policy and procedures, consider the following actions and discuss them with colleagues and managers.
1. Hirsch, C.H., et al., The Natural-History of Functional Morbidity in Hospitalized Older Patients. Journal of the American Geriatrics Society, 1990. 38(12): p. 1296-1303.
Understanding how patients move
It is important we understand our patients’ prior levels of ability and how they move and care for themselves in their usual living environments.
Mobility and self-care support independence
Maintaining mobility and self-care enables older people to maximise opportunities for independence, social connection, security, activity and dignity.
Identifying mobility or self-care issues
Screening and assessment can help us identify mobility and self-care issues and risk of falls, frailty, de-conditioning and loss of independence.
Maintaining and improving mobility and self-care
Interventions to support mobility and self-care can include incidental activity, exercise, retraining ADLs, supervision and environmental modifications.
Mobility and self-care in discharge planning
Discharge planning should be person-centred and undertaken with the patient and their family and carers.
Further information - mobility
Educational and information resources available on mobility and self-care in older people in hospital.
All public and private hospitals are required to be accredited to the Australian Commission on Safety and Quality in Healthcare’s (ACSQHC) National Safety and Quality Health Service (NSQHS) Standards. The primary aims of the standards are to protect the public from harm and to improve the quality of health service provision. Assessment to the second edition of the NSQHS Standards commenced in January 2019. The second edition comprises eight standards that provide a nationally consistent statement about the level of care consumers can expect from health services.
The Comprehensive Care Standard (Standard 5) aims to ensure that patients receive comprehensive health care that meets their individual needs, and considers the impact of their health issues on their life and wellbeing. It also aims to ensure that risks of harm for patients during health care are prevented and managed through targeted strategies. These include integrating patient care processes to identify patient needs and identifying actions related to falls, pressure injuries, nutrition, mental health, cognitive impairment and end-of-life care.
Information is presented in the Older People in Hospital learning topics that complements Standard 5 and other NSQHS Standards including the; Partnering with Consumers Standard (Standard 2), Medication Safety Standard (Standard 4), Communicating for Safety Standard (Standard 6) and Recognising and Responding to Acute Deterioration (Standard 8).
Reviewed 04 October 2015