| Title: | Investigating and Preventing the Loss of Muscle Strength and Physical Function in Frail Older Adults Who Experience an Unplanned Period of Hospitalisation |
| Background: | During a period of hospitalisation many older people develop new disability. There is much evidence to suggest that one of the main reasons for this is the level of inactivity in hospital wards. Even during a relatively short period of inactivity, muscles, particularly in the legs, lose strength. In fit younger adults this can be inconsequential, and quickly recovered. In frail older adults even a very small loss of strength can have severe consequences. It could for instance be the difference between being able to stand up from a chair without assistance, and requiring physical help to stand. Changes in muscle strength occur before changes in ability to move around and manage day-to-day activities. We believe that measuring changes in muscle should allow us to identify not only people who are less mobile, but also those who risk becoming less mobile in the near future.
Before testing whether an exercise programme prevents older people developing new disability whilst in hospital, we believe that we need to study the changes in muscle during hospitalisation. For instance, during discussions with patients and members of the public, it has been suggested that it necessary to know when changes occur to muscle strength, so as to decide how early it is necessary to start an exercise programme. This work will form Phase 1 of the research, and will tell us who we need to target, and how many people we will need to include in the eventual main study, to test the effectiveness of an exercise programme. Phase 2 of the research will be a small version of the main study that I plan to run as my post-doctoral work. It will test that all aspects of the planned study run smoothly and are feasible. |
| Methodology description: | The Phase 1 study will recruit 105 patients admitted to the wards of the Department of Medicine for the Elderly. We will take various measurements that we think may predict the risk of developing new disability, such as age and gender, measures of memory and fear of falling. In addition, on admission to hospital and at discharge (or day 7 of admission if earlier) we will take measures of muscle strength, and how well the patient can get around. We will repeat the test of muscle strength every day for the first 7 days so as to measure change during the patient’s hospital stay. One month after discharge, a researcher will visit the patient to repeat the measurements of muscle strength and mobility one last time. We will use the information from Phase 1 to inform Phase 2 (and the eventual main study).
The Phase 2 feasibility study will recruit 40 patients admitted to the wards of the Department of Medicine for the Elderly. If patients agree to participate, they will be randomly assigned to one of two groups. The first group will receive an exercise programme designed to strengthen their leg muscles two times a day, supervised by a physiotherapy assistant. The second group will receive a sham programme designed not to benefit the muscles. Muscle strength and mobility will be measured at the beginning of the study, at discharge from hospital, and one month after discharge. The participants will be interviewed at discharge from hospital so as to understand the acceptability of the programme, and to understand what prevented or aided full participation. The physiotherapy assistants will also be interviewed in an effort to make sure future studies can be refined and improved to maximise participation. In addition, this study will provide us information such as the number of participants we can expect to recruit, and the rate at which we can expect to recruit them in future studies. |
| Outcome measure description: | After we complete this work, we plan to complete the larger, main study to test definitively whether the exercise programme prevents or reduces new disability in older adults during hospitalisation, and is cost effective. We then hope to be able to provide an evidence-based argument to introduce the exercise programme as part of normal hospital care. |
| Project organisation | |
| Start date: | 2nd October 2017 |
| End date: | 30th September 2020 |
| Contact person: | Mr Peter Hartley |
| Contact Details: | Primary Care Unit Institute of Public Health University Forvie Site, Robinson Way Cambridge Cambs CB2 0SR UK Telephone: (01223) 331841 Fax: 01223 762515 E-mail: ph492@cam.ac.uk |
| Collaborative: | Professor Christi Deaton Dr Roman Romero-Ortuno Dr Ian Wellwood |
| Funding information | |
| Funding Organisation: | Dunhill Medical Trust |
| Funding Reference: | Dunhill Medical Trust Research Training Fellowship |
| Funding Amount: | £163,243 |
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| Funding Organisation: | ACT (Addenbrooke’s Charitable Trust) |
| Funding Reference: | |
| Funding Amount: | £16,745 |
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| Further Information, References and Publications | |