Older adults in skilled nursing facilities demonstrate low physical activity during and after discharge

This study sought to quantify physical activity and sedentary time among older adults during a skilled nursing facility (SNF) stay and after the transition home, a critical period when patients are at high risk for adverse events.

We performed an observational cohort study of physical activity and sedentary behavior during the last 3-5 days before discharge from SNF and the initial 3-5 days at home using accelerometers. Participants answered questions about perceived physical activity in the SNF and at home.

A convenience sample of thirty-one residents from two SNFs were included. Participants spent a median 12.2% (interquartile range [IQR], 17.3%) of time upright in the SNF and 16.8% (IQR, 15.2%) of their time upright at home (p = 0.002) and took a median of 849 steps (IQR, 1772) in the SNF and 922 steps (IQR, 1906) at home (p = 0.57), per day. Participants averaged fewer sitting bouts at home (p = 0.03), but there was no difference in sit-to-stand transitions (p = 0.32) or activity scores (p = 0.67). Subjective perceptions of physical activity appeared to be higher than objective measurements.

In an exploratory study, SNF residents demonstrated profoundly low levels of physical activity both during and after their SNF stay. Future studies using larger sample sizes should examine physical activity during the SNF to home transition as well as barriers and facilitators to physical activity in post-acute care environments.IMPLICATIONS FOR REHABILITATIONSNF residents in this study demonstrated low levels of physical activity and high rates of sedentary behavior that persisted after discharge home.Interventions to improve physical activity levels in the SNF are sorely needed, and those interventions should include a plan for progressing physical activity after the transition home.Objective measurement of physical activity using activity monitors may prove clinically useful for older adults following hospitalization in the SNF and home settings.