Export file:


  • RIS(for EndNote,Reference Manager,ProCite)
  • BibTex
  • Text


  • Citation Only
  • Citation and Abstract

Older adults’ activity on a geriatric hospital unit: A behavioral mapping study

1 Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Spain; Institute for Biomedical Research (ibs), Granada, Spain
2 Department of Physical Medicine and Rehabilitation, Virgen de las Nieves University Hospital, Granada, Spain
3 PA-HELP “Physical Activity for HEaLth Promotion” Research Group. Department of Physiotherapy, University of Granada, Granada, Spain
4 Centre for Hip Health and Mobility, Vancouver, Canada
5 Department of Family Practice, The University of British Columbia, Canada
6 Simon Fraser University, Burnaby, Canada
7 Vancouver Coastal Health Authority, Canada
8 Department of Physical Therapy, The University of British Columbia, Canada
9 Department of Medicine, The University of British Columbia, Canada
10 School of Psychology, The University of Adelaide, Australia

Special Issues: Reducing Sedentary Behavior after Hospitalization for Musculoskeletal Trauma

Background: Systematic reviews highlight a preponderance of prolonged sedentary behavior in the hospital setting, with possible consequences for patients’ health and mobility. To date, most of the published literature in this field focus on the hospital experience for older adults with dementia or stroke. Few data describe hospital activity patterns in specialized geriatric units for frail older adults, who are already at risk of spending prolonged periods of time sitting. Yet, promoting older adults’ activity throughout hospitalization, when possible, is an avenue for exploration to identify opportunities to encourage more daily functional activities, and minimize the risk of post-hospital syndrome. Methods: This was a two-part observational study to describe (1) the hospital indoor environment and (2) patients’ activity patterns (using behavioral mapping) within public areas of two hospital units. One combined-trained physiotherapist and occupational therapist recorded information on indoor environmental features for two acute geriatric hospital units, such as potential opportunities for sitting and walking (i.e., handrails, chairs, benches, etc.), and identified obstacles which may impede activity (i.e., food or laundry carts in hallways, etc.). The observer also systematically scanned these units every 15 minutes (8 am to 4 pm) over two days/unit (one weekday and one weekend day) using standard behavioral mapping methods. There were three to four observation stations identified on each unit to count the number of people who were present, distinguish their role (patient, visitor), approximate age, gender, and body position or activity (sitting, standing, walking). We did not enter patients’ rooms. We described units’ indoor environment, and observed activity for each unit. We used Chi square tests to compare differences in observations between units, day of the week, and gender. Results: For both units there were similar indoor environmental features, with the exception of the floorplans, number of beds, minor differences in flooring materials, and an additional destination room (two lounges attached to one unit). Both units had items such as laundry carts against walls in hallways, blocking handrails, when present. We observed between 46–86% (average 60%) of admitted patients in the public areas of hospital units, with variability depending on unit and day: More than half of the observations were of patients sitting. Approximately 20% of patients were observed more than once: This included five women and seven men. There were significant associations for gender and observations on weekdays (men > women; Chi square = 17.01, p < 0.0001), and weekend days (women > men; Chi square = 6.11, p = 0.013). There were more visitor observations on Unit 2. Conclusions: These exploratory findings are an opportunity to, generate hypotheses for future testing, and act as a starting point to collaborate with front line clinicians to highlight the indoor environment’s role in promoting activity, and develop future strategies to safely introduce more activity into the acute care setting for older adults.
  Article Metrics

Keywords behavioural mapping; built environment; hospital; mobility; older adults; sedentary behavior

Citation: Patrocinio Ariza-Vega, Hattie Shu, Ruvini Amarasekera, Nicola Y. Edwards, Marta Filipski, Dolores Langford, Kenneth Madden, Maureen C. Ashe. Older adults’ activity on a geriatric hospital unit: A behavioral mapping study. AIMS Medical Science, 2019, 6(1): 33-48. doi: 10.3934/medsci.2019.1.33


  • 1. Zusman EZ, Dawes MG, Edwards N, et al. (2018) A systematic review of evidence for older adults' sedentary behavior and physical activity after hip fracture. Clin Rehabil 32: 679–691.    
  • 2. Ekegren CL, Beck B, Climie RE, et al. (2018) Physical activity and sedentary behavior subsequent to serious orthopedic injury: A systematic review. Arch Phys Med Rehabil 99: 164–177.    
  • 3. Ostir GV, Berges IM, Kuo YF, et al. (2013) Mobility activity and its value as a prognostic indicator of survival in hospitalized older adults. J Am Geriatr Soc 61: 551–557.    
  • 4. Barnes J, Behrens TK, Benden ME (2012) Letter to the editor: Standardized use of the terms "sedentary" and "sedentary behaviours". Appl Physiol Nutr Metab 37: 540–542.    
  • 5. Tremblay MS, Aubert S, Barnes JD, et al. (2017) Sedentary behavior research network (SBRN)-terminology consensus project process and outcome. Int J Behav Nutr Phys Act 14: 75.    
  • 6. Caspersen CJ, Powell KE, Christenson GM (1985) Physical activity, exercise, and physical fitness: Definitions and distinctions for health-related research. Public Health Rep 100: 126–131.
  • 7. Hamilton MT, Hamilton DG, Zderic TW (2004) Exercise physiology versus inactivity physiology: An essential concept for understanding lipoprotein lipase regulation. Exerc Sport Sci Rev 32: 161–166.
  • 8. Stevens-Lapsley JE, Loyd BJ, Falvey JR, et al. (2016) Progressive multi-component home-based physical therapy for deconditioned older adults following acute hospitalization: A pilot randomized controlled trial. Clin Rehabil 30: 776–785.    
  • 9. Gill TM, Gahbauer EA, Han L, et al. (2011) The relationship between intervening hospitalizations and transitions between frailty states. J Gerontol A-Biol 66: 1238–1243.
  • 10. Lim SER, Dodds R, Bacon D, et al. (2018) Physical activity among hospitalised older people: Insights from upper and lower limb accelerometry. Aging Clin Exp Res 30: 1363–1369.    
  • 11. Grimandi R, Paupy H, Prot H, et al. (2015) Early Mobilization in ICU: About New Strategies in Physiotherapy's Care. Crit Care Med 43: e400.    
  • 12. Talkowski JB, Lenze EJ, Munin MC, et al. (2009) Patient participation and physical activity during rehabilitation and future functional outcomes in patients after hip fracture. Arch Phys Med Rehabil 90: 618–622.    
  • 13. Growdon ME, Shorr RI, Inouye SK (2017) The tension between promoting mobility and preventing falls in the hospital. JAMA Intern Med 177: 759–760.    
  • 14. Lay S, Bernhardt J, West T, et al. (2016) Is early rehabilitation a myth? Physical inactivity in the first week after myocardial infarction and stroke. Disabil Rehabil 38: 1493–1499.
  • 15. Bell PA, Smith JM (1997) A behavior mapping method for assessing efficacy of change on special care units. Am J Alzheimer's Dis 12: 184–189.    
  • 16. Storti KL, Pettee KK, Brach JS, et al. (2008) Gait speed and step-count monitor accuracy in community-dwelling older adults. Med Sci Sport Exer 40: 59–64.
  • 17. Milke DL, Beck CH, Danes S, et al. (2009) Behavioral mapping of residents' activity in five residential style care centers for elderly persons diagnosed with dementia: Small differences in sites can affect behaviors. J Hous Elderly 23: 335–367.    
  • 18. Gustafsson L, McKenna K (2010) Is there a role for meaningful activity in stroke rehabilitation? Top Stroke Rehabil 17: 108–118.    
  • 19. Gustafsson L, Nugent N, Biros L (2012) Occupational therapy practice in hospital-based stroke rehabilitation? Scand J Occup Ther 19: 132–139.    
  • 20. Janssen H, Ada L, Karayanidis F, et al. (2012) Translating the use of an enriched environment poststroke from bench to bedside: Study design and protocol used to test the feasibility of environmental enrichment on stroke patients in rehabilitation. Int J Stroke 7: 521–526.    
  • 21. Sjoholm A, Skarin M, Churilov L, et al. (2014) Sedentary behaviour and physical activity of people with stroke in rehabilitation hospitals. Stroke Res Treat 2014: 591897.
  • 22. Skarin M, Sjoholm A, Nilsson A, et al. (2013) A mapping study on physical activity in stroke rehabilitation: Establishing the baseline. J Rehabil Med 45: 997–1003.    
  • 23. West T, Bernhardt J (2012) Physical activity in hospitalised stroke patients. Stroke Res Treat 2012: 13.
  • 24. Jayadevappa R, Bloom BS, Raziano DB, et al. (2003) Dissemination and characteristics of acute care for elders (ACE) units in the United States. Int J Technol Assess Health Care 19: 220–227.    
  • 25. Ahmed NN, Pearce SE (2010) Acute care for the elderly: A literature review. Popul Health Manag 13: 219–225.    
  • 26. Lai L, Wong R (2017) Leading best practice: Acute Care for Elders Units (ACE)-evidence and keys to successful operation. Can Geriatr J CME 7: 1–9.
  • 27. Wong R, Shaw M, Acton C (2003) Geriatrics today: An interdisciplinary approach to optimize health services in a specialized acute care for elders unit. J Can Geriatr Soc 6: 177–186.
  • 28. Amagasa S, Machida M, Fukushima N, et al. (2018) Is objectively measured light-intensity physical activity associated with health outcomes after adjustment for moderate-to-vigorous physical activity in adults? A systematic review. Int J Behav Nutr Phys Act 15: 65.    
  • 29. Chastin SFM, De Craemer M, De Cocker K, et al. (2018) How does light-intensity physical activity associate with adult cardiometabolic health and mortality? Systematic review with meta-analysis of experimental and observational studies. Br J Sports Med bjsports-2017.
  • 30. Fuzeki E, Engeroff T, Banzer W (2017) Health benefits of light-intensity physical activity: A systematic review of accelerometer data of the national health and nutrition examination survey (NHANES). Sport Med 47: 1769–1793.    
  • 31. Saint-Maurice PF, Troiano RP, Berrigan D, et al. (2018) Volume of Light Versus Moderate-to-Vigorous Physical Activity: Similar Benefits for All-Cause Mortality? J Am Heart Assoc 7: e008815.
  • 32. Piercy KL, Troiano RP, Ballard RM, et al. (2018) The physical activity guidelines for Americans. JAMA 320: 2020–2028.    
  • 33. Ashe MC (2018) Indoor Environments and Promoting Physical Activity Among Older People, In: The Palgrave Handbook of Ageing and Physical Activity Promotion, Springer, 467–483.
  • 34. McGregor AJ, Choo EK, Becker BM, et al. (2016) Sex and gender in acute care medicine. Online resource, 1.
  • 35. Lu Z (2010) Investigating walking environments in and around assisted living facilities: A facility visit study. HERD 3: 58–74.    
  • 36. Harris DD (2015) The influence of flooring on environmental stressors: A study of three flooring materials in a hospital. HERD 8: 9–29.    
  • 37. Kamdar BB, Martin JL, Needham DM (2017) Noise and Light Pollution in the Hospital: A Call for Action. J Hosp Med 12: 861–862.    
  • 38. Xyrichis A, Wynne J, Mackrill J, et al. (2018) Noise pollution in hospitals. BMJ 363: k4808.
  • 39. Ulrich RS, Berry LL, Quan X, et al. (2010) A conceptual framework for the domain of evidence-based design. HERD 4: 95–114.    
  • 40. Ng C (2016) Behavioral mapping and tracking, In: Gifford R (editor.), Research methods for environmental psychology, West Sussex, UK: John Wiley & Sons, ltd, 26–52.
  • 41. Lang PO, Meyer N, Heitz D, et al. (2007) Loss of independence in Katz's ADL ability in connection with an acute hospitalization: Early clinical markers in French older people. Eur J Epidemiol 22: 621–630.    
  • 42. Siu AL, Penrod JD, Boockvar KS, et al. (2006) Early ambulation after hip fracture: Effects on function and mortality. Arch Intern Med 166: 766–771.    
  • 43. Goldfarb M, Afilalo J, Chan A, et al. (2018) Early mobility in frail and non-frail older adults admitted to the cardiovascular intensive care unit. J Crit Care 47: 9–14.    
  • 44. Morri M, Forni C, Marchioni M, et al. (2018) Which factors are independent predictors of early recovery of mobility in the older adults' population after hip fracture? A cohort prognostic study. Arch Orthop Traum Su 138: 35–41.    
  • 45. Krumholz HM (2013) Post-hospital syndrome-an acquired, transient condition of generalized risk. N Engl J Med 368: 100–102.    
  • 46. Pannurat N, Thiemjarus S, Nantajeewarawat E (2014) Automatic fall monitoring: A review. Sensors 14: 12900–12936.    
  • 47. Gettens S, Fulbrook P (2015) Fear of falling: Association between the Modified Falls Efficacy Scale, in-hospital falls and hospital length of stay. J Eval Clin Pract 21: 43–50.    
  • 48. Schmid AA, Acuff M, Doster K, et al. (2009) Poststroke fear of falling in the hospital setting. Top Stroke Rehabil 16: 357–366.    
  • 49. Colley RC, Garriguet D, Janssen I, et al. (2011) Physical activity of Canadian adults: Accelerometer results from the 2007 to 2009 Canadian Health Measures Survey. Health Rep 22: 7–14.
  • 50. Winnett R, Furman R, Enterline M (2012) Men at risk: Considering masculinity during hospital-based social work intervention. Soc Work Health Care 51: 312–326.    
  • 51. Dunne TJ, Gaboury I, Ashe MC (2014) Falls in hospital increase length of stay regardless of degree of harm. J Eval Clin Pract 20: 396–400.    
  • 52. Babine RL, Hyrkas KE, Bachand DA, et al. (2016) Falls in A Tertiary Care Hospital-Association With Delirium: A Replication Study. Psychosomatics 57: 273–282.    
  • 53. Chen X, Van Nguyen H, Shen Q, et al. (2011) Characteristics associated with recurrent falls among the elderly within aged-care wards in a tertiary hospital: The effect of cognitive impairment. Arch Gerontol Geriat 53: e183–e186.    
  • 54. Prakash V, Shah MA, Hariohm K (2016) Family's presence associated with increased physical activity in patients with acute stroke: an observational study. Braz J Phys Ther 20: 306–311.    
  • 55. Tuckett AG, Banchoff AW, Winter SJ, et al. (2018) The built environment and older adults: A literature review and an applied approach to engaging older adults in built environment improvements for health. Int J Older People Nurs, 13.
  • 56. Rosso AL, Auchincloss AH, Michael YL (2011) The urban built environment and mobility in older adults: A comprehensive review. J Aging Res 2011: 816106.
  • 57. Rosbergen IC, Grimley RS, Hayward KS, et al. (2016) The effect of an enriched environment on activity levels in people with stroke in an acute stroke unit: Protocol for a before-after pilot study. Pilot Feasibility Stud 2: 36.    
  • 58. Rosbergen IC, Grimley RS, Hayward KS, et al. (2017) Embedding an enriched environment in an acute stroke unit increases activity in people with stroke: A controlled before-after pilot study. Clin Rehabil 31: 1516–1528.    
  • 59. Rosbergen ICM, Brauer SG, Fitzhenry S, et al. (2017) Qualitative investigation of the perceptions and experiences of nursing and allied health professionals involved in the implementation of an enriched environment in an Australian acute stroke unit. BMJ Open 7: e018226.    
  • 60. Phillips LJ, Petroski GF, Markis NE (2015) A comparison of accelerometer accuracy in older adults. Res Gerontol Nurs 8: 213–219.    
  • 61. Dogra S, Ashe MC, Biddle SJH, et al. (2017) Sedentary time in older men and women: An international consensus statement and research priorities. Br J Sports Med 51: 1526–1532.    


Reader Comments

your name: *   your email: *  

© 2019 the Author(s), licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution Licese (http://creativecommons.org/licenses/by/4.0)

Download full text in PDF

Export Citation

Copyright © AIMS Press All Rights Reserved