Mobility on discharge from an aged care unit

Investigators: Mr Edward Gorgon, Dr Cathy Said, Prof Mary Galea

Independent mobility is crucial to independent living and quality of life. Few studies have described mobility in older persons in an Australian aged care rehabilitation unit. Two studies were conducted concurrently to describe mobility in patients at the rehabilitation wards of the Heidelberg Repatriation Hospital.

The first study quantified mobility around the time of discharge in 95 patients (mean age 81 ± 8 years, 60% female) who were able to ambulate at least 10 metres and had no weight bearing restrictions. Independence level was rated on the mobility and locomotion sub-scales of the Functional Independence Measure (FIM). Time and distance gait characteristics were measured using the GAITRiteTM, an instrumented walkway (refer to Figure).

About 95% of participants were discharged home or to a hostel. Eighty-three per cent transferred independently to a bed/chair, 81% to the toilet, and 60% to the shower. Seventy-four per cent walked independently, with median (IQR) gait velocity at 45.96 (31.51) cm/s, whilst only 31% negotiated stairs independently.

The second study documented change in mobility in four patients with acute stroke (age range: 70-88 years). In addition to the measures utilized in the first study, measures of walking distance (Six-Minute Walk Test), motor function (Motor Assessment Scale) and quality of life (Assessment of Quality of Life Index) were also administered. Participants underwent intensive rehabilitation and assessments at baseline, four weeks after and six months post stroke. Mobility improved in two participants after four weeks of rehabilitation but declined on follow-up. Another participant improved from baseline through follow-up, whilst one demonstrated no change.

Findings of both studies indicate that, whilst many patients achieve mobility required for function indoors, few have the level required for function in the community. For example, only 9.5% walked with a gait velocity of at least 80 cm/s which is considered a cut-off for community ambulation. This highlights the need for ongoing rehabilitation for many of these patients. Furthermore, both studies demonstrate the importance and feasibility of using multiple measures to adequately describe the different aspects of mobility.

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