In-hospital mobility impairment in older MI patients predicts postdischarge functional decline


Background: The ability to independently perform daily activities is highly valued by patients, yet it is commonly impaired in older adults after hospitalization for MI. Risk of functional decline in this population is not well understood, but may relate to reduced mobility while hospitalized.

Study design: Prospective cohort.

Setting: A total of 94 academic and community hospitals in the United States.

Synopsis: More than 3,000 adults aged 75 years and older who were hospitalized for acute myocardial infarction were enrolled in the prospective cohort SILVER-AMI; 2,587 patients within this cohort were evaluated for in-hospital mobility with the Timed “Up and Go” test. At 6-month follow-up, loss of independent performance of activities of daily living (ADL) and of the ability to walk 0.25 miles were both associated in a dose-dependent manner with in-hospital mobility. Severe in-hospital mobility impairment was associated with ADL decline with an adjusted odds ratio of 5.45 (95% confidence interval, 3.29-9.01).

While in-hospital mobility is predictive of future functional decline in this population, this observational study cannot establish whether attempts to improve mobility in hospitalized patients will prevent future functional decline.

Bottom line: Lower performance on the Timed “Up and Go” test of mobility among older patients hospitalized for MI is associated with functional decline 6 months after hospitalization.

Citation: Hajduk AM et al. Association between mobility measured during hospitalization and functional outcomes in older adults with acute myocardial infarction in the SILVER-AMI study. JAMA Intern Med. 2019 Oct 7. doi: 10.1001/jamainternmed.2019.4114.

Dr. Gerstenberger is a hospitalist and clinical assistant professor of medicine at the University of Utah, Salt Lake City.

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