Geriatric evaluation and management inpatients spend little time participating in physically, cognitively or socially meaningful activity: a time-motion analysis

BACKGROUND

Geriatric Evaluation and Management (GEM) services provide subacute care for older adults with complex conditions. Meaningful activities are important for preventing functional decline in hospitalised older adults; however, no studies have evaluated GEM inpatients' participation in such activities.

OBJECTIVE

To determine the proportion of time GEM inpatients spend performing meaningful activities during the day and investigate whether ward environments and day of the week are associated with activity levels.

METHOD

This observational study used behavioural mapping to audit inpatients across three GEM wards. Observations were made at 10-minute intervals over 12 consecutive hours on weekdays and 10.5 hours on weekend days. Activities were categorised as physical, cognitive or social. Logistic mixed models were used to analyse factors associated with engagement in meaningful activities.

RESULTS

In total, 60 030 minutes were observed among 70 inpatients. Overall, GEM inpatients spent 16%, 6% and 18% of observed time in physically, cognitively and socially meaningful activities, respectively. Weekend days were associated with higher odds of cognitive engagement (OR 4.79, 95% CI 1.71-13.41, P = .003) but lower odds of social engagement (OR 0.57, 95% CI 0.38-0.85, P = .006). Time spent outside patients' rooms was positively associated with all types of meaningful activities. The odds of physically meaningful activity were not found to vary between weekends and weekdays.

CONCLUSIONS

GEM inpatients demonstrate lower engagement in meaningful activities compared to rehabilitation contexts. The positive association between activity levels and time spent outside patients' rooms emphasises the importance of accessible communal areas. Interventions to promote active participation are needed in inpatient GEM settings.

Mapping Healthcare Spaces: A Systematic Scoping Review of Spatial and Behavioral Observation Methods

OBJECTIVE

To provide a taxonomy of spatial observation methods that are commonly used in healthcare environments research and to describe their relative success.

BACKGROUND

Spatial observation is a valuable but resource intensive research method that is often used in healthcare environments research, but which frequently fails to deliver conclusive results. There is no existing catalog of the different spatial and behavioral observation methods that are used in healthcare design research and their benefits or limitations.

METHODS

The review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Ten key databases were searched, and articles were screened by both authors.

RESULTS

Across 67 included studies, 79 observation methods were reported. We categorized those into four, distinct methodological approaches, outlining the benefits, limitations, and suitability of each for obtaining different types of results. Common limitations included difficulty generalizing to other contexts and a lack of detailed description during data collection which led to key environment variables not being recorded. More concrete conclusions were drawn when observation methods were combined with complimentary methods such as interview.

CONCLUSIONS

The relative success of spatial observation studies is dependent on the fit of the method selected relative to the research question, approach, and healthcare setting; any complimentary methods delivered alongside it; and the analysis model employed. This article provides researchers with practical advice to guide the appropriate selection of spatial observation methods.

Can a new ward environment and intensive allied health staffing model enhance therapeutic opportunities in trauma care? A behavioural mapping study of patients' activities and interactions

OBJECTIVE

The aim of this study was to assess changes in patient activities and interactions observed in response to a new trauma ward at a level 1 trauma centre, and subsequently, a new allied health staffing model.

DESIGN

Explorative case study using behavioural mapping.

SETTING

Level 1 trauma centre in Melbourne, Australia.

PARTICIPANTS

Hospitalised trauma patients.

MAIN MEASURES

Behavioural mapping of patients' activities and interactions was conducted by two observers over three 4-day observation phases: (i) at baseline, (ii) on the new ward and (iii) with the new staffing model. Changes in activities and interactions were assessed via negative binomial regression models and reported as incident rate ratios.

RESULTS

In total, 1264 patient observations were recorded over an 18-month period. After moving to the new ward, patients were observed performing activities of daily living at a 2.1-fold higher rate than at baseline (95% confidence interval: 1.18, 3.81) but walking/standing/climbing stairs 54% less (95% confidence interval: 0.22, 0.94). Subsequent to the new staffing model, patients were observed in the gym at a 4.1-fold higher rate (95% confidence interval: 1.60, 10.32) and interacting with allied health professionals at a 9.1-fold higher rate (95% confidence interval: 4.88, 16.98), than at baseline. After COVID-19 restrictions were introduced, patients were observed lying down 22% more (95% confidence interval: 1.04, 1.43), with 73% fewer visitor interactions (95% confidence interval: 0.17, 0.43).

CONCLUSIONS

Greater engagement in physical and social activities was observed following the implementation of the new allied health staffing model at a level 1 trauma centre. Whether these changes translate to improved trauma outcomes is important to investigate.