help optimise and mobilise elders (h.o.m.e)

Conditions: Mobility Limitation; Functional Disturbance

Summary: during hospitalisations, older inpatients commonly face issues such as immobility, loss of independence, and functional decline. this leads them down the cascade of dependency with consequent increased risk of adverse outcomes, institutionalisation as well as higher post-acute care costs. the investigators hypothesize that by implementing a mobility intervention in the inpatient setting, patients would be able to maintain their function upon discharge and avoid the cascade of dependency. as such, the investigators aim to do this by implementing and evaluating a mobility intervention, while optimising reversible factors affecting mobility among inpatients admitted to a geriatric unit in singapore. the investigators will also examine the cost impact of a mobility focused model of care and also adopt the effectiveness-implementation hybrid type 2 design where both effectiveness and implementation spheres are tested simultaneously.

aim 1: to examine the effectiveness of multicomponent, mobility-focused model of care in reducing iatrogenic complications and improving patient outcomes. adopting the institute for healthcare improvement's (ihi) 4ms framework ("mobility", "mentation, "medication", and "what matters"), the investigators will examine the effectiveness of timely and individually catered mobility interventions which not only increase mobilization but also optimize factors inhibiting mobility for elderly inpatients. it is hypothesized that the mobility outcomes, such as maximum distance walked and mobilization frequency will be significantly improved for patients who receive the intervention compared to those who receive standard care. aim 2: to examine the cost impact of a mobility-focused model of care. the investigators will examine whether the cost of these multicomponent, mobility-focused interventions can be offset from cost savings from early mobilisation benefits, by comparing healthcare utilization costs between-groups. further to that, a cost effectiveness analysis will be performed should functional effectiveness be observed. for the primary cost impact objective, it is hypothesized that the cost savings arising from reduction in bed days of hospitalization and other medical costs incurred during study period will outweigh the cost of implementing this model of care. in addition, it is also hypothesized that the proposed intervention will be cost-effective through achieving better functional outcomes for patients, with lower costs required. aim 3: to evaluate the implementation outcomes of multicomponent, mobility-focused model of care in the process of this intervention. it is hypothesized that this intervention will have good acceptability, feasibility, penetration, implementation costs and sustainability.

Eligibility criteria:
inclusion criteria: * newly admitted patients to the geriatric service * aged 75 years and above * mobile with or without the use of a walking aid exclusion criteria: * vancomycin-resistant enterococcus (vre) status * requires droplet or airborne precautions * critically ill * haemodynamically instability * requires more than 4-hourly parameters * systolic blood pressure \<90 mmhg * heart rate \>100beats/min * non-ambulant patients * with advanced dementia (functional assessment staging scale \[fast\] 7 dementia) * fulfills direct admission to another subspecialty unit

Keywords: elderly geriatric mobility inpatient functional decline mobility intervention gait speed maximum distance walked cost impact length of stay multidisciplinary implementation study 4ms (mobility, mentation, medication, what matters) nursing screen group therapy