Facilitating early activities of daily living retraining to prevent functional decline in older adults

Older people admitted to acute hospitals are at risk of functional decline. There is limited research into strategies that reduce such risks. The aim of this study was to investigate whether individualised activities of daily living retraining programmes improve functional outcomes, influence the choice of discharge destinations and reduce length of stay for older people in acute care.

A pilot non-randomised controlled study (pre-test/post-test) with block allocation to control and intervention groups was undertaken in an acute geriatric unit at a large teaching hospital. The study was conducted over a six-month period in two consecutive blocks. The intervention group received activities of daily living retraining three times per week for up to one hour per session. The control group received standard, mainly assessment-based occupational therapy services. The Modified Barthel Index was used to measure functional status on admission and discharge.

At discharge, there was no statistical difference in the change of total Modified Barthel Index score between control and intervention groups. Of the 10 items scored on the Modified Barthel Index, ambulation and chair/bed transfers approached significance (P = 0.0603 and P = 0.0547 respectively). No evidence was found for a difference in length of stay between intervention and control groups (mean length of stay 15.2 vs. 11.7 days respectively, P = 0.19). Raw data suggested that retraining programmes may reduce the level of care patients required on discharge.

Trends from this study indicate that functional retraining programmes could be effective in preventing functional decline. Further research is needed to reach more definite conclusions.