Why hospitalised older people are inactive and how volunteers can help. A qualitative study

Abstract

Excessive bed rest and sedentary behaviour in older inpatients are well recognised problems within the NHS which can contribute to a range of negative effects such as infections, thrombosis, pressure damage to skin, urinary incontinence, constipation, mental health issues, loss of muscle and deconditioning. Due to ever increasing time pressures on nursing staff in the NHS, other aspects of care (such as medical treatments, washing and feeding) take priority over frequent daily mobilisation of patients. Volunteers have been used in some hospitals worldwide to assist with mobilisation in older people with promising results.

This qualitative study aimed to gain views and perceptions of patients, caregivers, staff and volunteers with regards to volunteer‐led mobilisation of older patients on acute medical wards. The study also investigated perspectives on hospitalisation in general, barriers to mobilisation and suggestions for improvements in the care of older people.

20 patients, 7 family members, 27 staff and 3 mealtime volunteers participated in either individual interviews or focus groups which were audio recorded, transcribed, coded and analysed according to the Framework method.

The results of the study were grouped into five main topics:
1. The hospitalised older adult which includes the concept of institutionalisation and disempowerment of the frail patient, advantages and disadvantages of hospitalisation
2. Mobility of inpatients which includes description of mobilisation practice in hospital, views on importance of keeping active in older age and awareness of bed rest risks.
3. Barriers to mobilisation which were grouped into environmental, patient related, staff related and family related themes.
4. Volunteer‐led walking programme with following areas to consider prior to implementation: patient selection, volunteer selection, environmental issues, staff related issues.
5. Proposed changes which could help improve mobility of older people and care in general.

There are many ways in which the hospital environment, staff and even family members can add to the disempowerment in older inpatients which in turn results in increased social care requirements‐ institutional, cultural and organisational factors are all contributive. Early mobilisation could become a good, simple way of empowerment. Close inspection of barriers to mobilisation and searching for ward or hospital specific solutions to overcome them could support the paradigm shift. In this context, training volunteers to assist with mobilisation would provide a strong message not only to patients and caregivers but also to all types and grades of hospital staff. This work provides a multi‐layered insight into the care of older patients in a large NHS hospital. The ideas, reflections and inferences derived from this study mirror the current climate in the NHS and provide evidence that a shift in perception has already happened. My interviewees have created a story that I attempted to unveil and systematise so that at least parts of it can be translated into practical solutions in day‐to‐day clinical practice.

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Identifiers

ORCID for Helen Roberts: orcid.org/0000-0002-5291-1880

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