Mobilitätsförderung im interdisziplinären Raum der geriatrischen Langzeitpflege : eine Prä- und Poststudie zur Mobilitätsförderung im Alter (MiA)

Abstract

Author: Elke Schlesselmann; Bremen, den 13.05.2014 Title: Mobility-enhancement in interdisciplinary geriatric long-term care A longitudinal study on elderly patients The MiA-study (Mobilität im Alter / mobility in the elderly) was carried out in 14 long-term care units of the Bremer Heimstiftung between 2010 2013. The study comprised 45 patients, 39 of which were female and six male. Participants were on average 84,2 years old and were suffering from cognitive as well as physical impairments, which is common for residents in geriatric long-term care units. Of the patients enrolled in this study, 58% were diagnosed with dementia and 31% with depression. A majority of 78% of the patients was in need of assistance to plan day-to-day activities, 73% had decreased mobility, and 47% suffered from pain. Many residents complained about intermittent or permanent fatigue. The residents chosen for this study had an increased risk of turning immobile. They had a greater tendency to either fall or to phase out, or had problems to move independently. The patients were subject to a geriatric assessment and individual interdisciplinary mobility-enhancing interventions were compiled and decided. They were implemented for a period of three month, followed by a re-assessment. The individual composition of the mobility-enhancing interventions was based on personal preference, target-activity, potentials and weaknesses as well as the current knowledge in the field of mobility-enhancing interventions. The findings in the observed model residents shall be translated to other, similar cases. This inductive approach should allow care unit staff to spot regularities and draw general conclusions from individual cases. Case conferences proved to represent an effective means of communication since they enhanced personnel development as well as a reflective view with respect to elderly patients. Thirty patients (66%) achieved the aims set out by themselves, by a close contact, or by a personal representative. Another seven patients partly achieved their aims, whereas eight residents failed to achieve their aims. The mobility as measured by the Tinetti score plus walking distance was not significantly altered by the mobility-enhancing interventions. However, mobility according to a self-grading system (grades 1 6) was significantly improved (Wilcoxon Test: 0.002). Further significant improvements were also identified with regard to well-being (Wilcoxon Test: 0.013) and the ability to move independently (Wilcoxon Test: 0.050). Day-to-day activities (such as washing, dressing, using the toilet, and feeding), were found not to be significantly improved. Food intake, however, was comparatively better in many patients after the applied interventions. In conclusion, this study showed that besides individual factors (e.g. motivation and health) also the environment in long-term care units must encourage mobility, provided that mobility-enhancement shall become an integral part of everyday life in elderly.