WWW.DISSERTATION.XLIBX.INFO
FREE ELECTRONIC LIBRARY - Dissertations, online materials
 
<< HOME
CONTACTS



Pages:   || 2 | 3 | 4 | 5 |   ...   | 14 |

«Posture, Mobility, and 30-day Hospital Readmission in Older Adults with Heart Failure by Theresa A. Floegel A Dissertation Presented in Partial ...»

-- [ Page 1 ] --

Posture, Mobility, and 30-day Hospital Readmission

in Older Adults with Heart Failure

by

Theresa A. Floegel

A Dissertation Presented in Partial Fulfillment

of the Requirements for the Degree

Doctor of Philosophy

Approved July 2015 by the

Graduate Supervisory Committee:

Matthew Buman, Chair

Cheryl Der Ananian

Jared Dickinson

Steven Hooker

Marianne McCarthy

ARIZONA STATE UNIVERSITY

August 2015

ABSTRACT

Background: Heart failure is the leading cause of hospitalization in older adults and has the highest 30-day readmission rate of all diagnoses. An estimated 30 to 60 percent of older adults lose some degree of physical function in the course of an acute hospital stay.

Few studies have addressed the role of posture and mobility in contributing to, or improving, physical function in older hospitalized adults. No study to date that we are aware of has addressed this in the older heart failure population.

Purpose: To investigate the predictive value of mobility during a hospital stay and patterns of mobility during the month following discharge on hospital readmission and 30-day changes in functional status in older heart failure patients.

Methods: This was a prospective observational study of 21 older (ages 60+) patients admitted with a primary diagnosis of heart failure. Patients wore two inclinometric accelerometers (rib area and thigh) to record posture and an accelerometer placed at the ankle to record ambulatory activity. Patients wore all sensors continuously during hospitalization and the ankle accelerometer for 30 days after hospital discharge. Function was assessed in all patients the day after hospital discharge and again at 30 days postdischarge.

Results: Five patients (23.8%) were readmitted within the 30 day post-discharge period.

None of the hospital or post-discharge mobility measures were associated with readmission after adjustment for covariates. Higher percent lying time in the hospital was associated with slower Timed Up and Go (TUG) time (b =.08, p =.01) and poorer hand grip strength (b = -13.94, p =.02) at 30 days post-discharge. Higher daily stepping i activity during the 30 day post-discharge period was marginally associated with improvements in SPPB scores at 30 days (b =.001, p =.06).

Conclusion: For older heart failure patients, increased time lying while hospitalized is associated with slower walking time and poor hand grip strength 30 days after discharge.

Higher daily stepping after discharge may be associated with improvements in physical function at 30 days.

ii

–  –  –

This dissertation would have remained a dream for me had it not been for the many people at Arizona State University who stood behind and beside me. It is with immense gratitude that I acknowledge my committee chair and mentor, Dr. Matthew Buman, for encouraging me to pursue my interests and push myself to achieve the most that I could in this program. You gave me the freedom to explore areas I found interesting, while providing the support to refine and develop my ideas. Your passion to share your research knowledge is not matched by anyone else I know. Because of you I feel I am prepared to embark on a new career in research.

Each of my committee members has played an important role in helping me transform into a true scientific researcher. Dr. Steven Hooker, Dr. Cheryl DerAnanian, Dr. Jared Dickinson, and Dr. Marianne McCarthy, many thanks to each of you for helping me realize my passion for Gerontological research, support along the way with your sound advice, critique, and encouragement, and professional friendship.

My research was supported by the Hartford Center for Gerontological Nursing Excellence Scholarship Program. Thank you Dr. Nelma Shearer and Dr. Adrianna Perez for your encouragement to apply to the program. You both have supported my development into a budding Gerontological nursing scholar.

Erin Krzywicki, my research assistant and colleague, who has been with me through my dissertation research journey, thank you for your professional support, hard work, and humor. You kept us sane and I could not have done this with you. Cheryl Dodson, Serena Roberts, heart failure coordinators, and Dr. Sabbath and Dr. Birkholz

–  –  –

their patients. I am deeply thankful for your support and professional friendship.

I am indebted to my doctoral cohort colleagues, Alberto Florez, Jessica Knurick, Andrew Miller, Wesley Tucker, and Wenfei Zhu, who helped me through this journey providing both academic and research support and personal friendship.

Lastly, and most importantly, I want to acknowledge and thank my husband, Michael, for his tireless support, love, and willingness to be my punching bag when needed. And my children, Courtney and Thomas, who have been schooling side-by-side with me, for their love and support, and ability to slip in humorous breaks from schoolwork (mine, not theirs) when I needed it.

.

–  –  –

LIST OF TABLES

LIST OF FIGURES

DEFINITIONS

CHAPTER 1 INTRODUCTION

Statement of the Problem

Specific Aim 1...

Hypotheses

Specific Aim 2…..





Hypotheses

2 LITERATURE REVIEW

Normal Aging versus Chronic Disease

Heart Failure in an Aging Population

Mobility Decline in an Aging Population

–  –  –

Mobility/Function Measurement in Hospitalized Older Adults and Associated Outcomes.

Mobility/Functional Interventions for Acute Hospitalization and Rehabilitation…………………………………………………………43 3 METHODS

Study Design

Participants

Human Subjects

Inclusion Criteria

Recruitment

Procedures

Measures

Demographics

Wearable Monitors

Independent Variables

Outcome Variables

Study Covariates

Statistical Analysis

Aim 1

Aim 2

–  –  –

Normality Testing

Data Selection for Prediction Models

4 RESULTS

Sample………………………………………………………………..72

–  –  –

Functional Outcomes

Regression Models

–  –  –

5 DISCUSSION

Summary of Findings

Specific Aim 1

Specific Aim 2

Strengths and Limitations

–  –  –

Future Directions

6 CONCLUSION

REFERENCES

–  –  –

APPENDIX A PHOTOS AND PLACEMENT DIAGRAM OF MONITORS............... 120 B PATIENT AND STAFF INFORMATION

C TRACTIVITY INFORMATION FOR HOME MONITORING............ 126

–  –  –

1. Normative Values for Timed Up and Go Test

2. Hospital Metrics for Analysis……………….…………………………………….58

3. Post discharge Metrics for Analysis

4. Pearson Correlation Coefficients for Activity Measures

5. Covariates, Aim 1

6. Covariates, Aim 2

7. Demographic and Health History of Heart Failure Participants

8. Hospital Characteristics of Participants

9. Percent of Hospital Day in Three Postures, Number Transitions, Steps/Day........ 78 10. 30 Day Post Discharge Step Activity

11. Functional Outcomes

12. Associations and Odds Ratios of Hospital Metrics

13. Associations between Hospital Metrics and Function

14. Associations and Odds Ratios of Discharge Metrics……………………………...86

15. Associations between Changes in Mobility and Function ……………......……..87

–  –  –

1. Measurement of Physical Function and Physical Activity in Older Adults …... 23

2. Study Timeline

3. Normality Plot I …..

4. Normality Plot II

5. Normality Plot III

6. Flow Diagram of Participant Recruitment and Retention …..

7. Association between Lying Time and TUG Scores

8. Association between Lying Time and Hand grip Strength

9. SPPB Score Increase and Mean Stepping from Post-Discharge Day 1 to 30.…. 88

–  –  –

Mobility— the ability of an individual to purposively move about his or her environment (Rosso, Taylor, Tabb, & Michael, 2013).

Functional decline—the decrement in physical and/or cognitive functioning that occurs when a person is unable to engage in activities of daily living.

Functional independence—the ability to perform daily living activities safely and autonomously (Covinsky et al., 2003).

Length of stay—based on 24-hour clock, the number of days residing in the hospital, including day of admission and day of discharge.

Comorbidity—the simultaneous presence of 2+ morbid conditions or diseases in the same person (Segen, 2002).

Readmission—a subsequent unplanned hospital admission within 30 days following an original admission.

Heart failure class I, II, III, IV— the New York Heart Association Functional

Classification System (NYHA) classifies heart failure patients according to three criteria:

1) limitations on physical activity, 2) symptoms (e.g. fatigue) and, 3) patient status at rest.

Class I patients have cardiac disease present but suffer no symptoms during rest or

–  –  –

physical activity. They are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea or anginal pain. Class III patients have cardiac disease resulting in marked limitation of physical activity. They are comfortable at rest. Less than ordinary activity causes fatigue, palpitation, dyspnea or anginal pain. Class IV patients suffer symptoms of fatigue, dyspnea, or angina pain to a degree at rest and with any level of physical activity (Dolgin, 1994).

Ejection Fraction—a measurement of how much blood the left ventricle pumps out with each contraction (Huether & McCance, 2008). For example, an ejection fraction of 60 percent means that 60 percent of the total amount of blood in the left ventricle is pushed out to the systemic circulation with each heartbeat.

Brain-Type Natriuretic Peptide (BNP)—a blood marker for prognosis and risk stratification in heart failure. BNP levels are highly correlated with the severity of heart failure but does not provide a definitive diagnosis (Kim & Januzzi, 2011).

Hand-Held Dynamometry—portable device that can be used to obtain objective measures of upper extremity strength during manual muscle testing (Roberts et al., 2014).

–  –  –

Over the next two decades, the older adult population (ages 65+) in the United States will more than double from 30 million to 80 million and older elderly adults— those more than 75 years of age —will soon have the highest growth rate of any age group (U. S. Centers for Disease Control and Prevention, 2012). Aging is associated with a higher prevalence of chronic disease that can negatively affect the older adult’s physical and functional abilities (Covinsky et al., 2003). An estimated 80 percent of older adults in the U. S. currently suffer from one or more chronic conditions (U. S. Centers for Disease Control and Prevention, 2011). Heart failure—a major chronic health condition of older age—greatly contributes to decline in the older adult’s physical function level, thus affecting self-care abilities. As heart failure progresses older adults often experience frequent exacerbations from which they may not fully recover. This continued decline places the heart failure population at a high risk for dependence on others and is a catalyst to frequent hospitalization and long-term institutionalization. In spite of modern therapies, half of older adults diagnosed with heart failure will die within five years (Go et al., 2014) and quality of life deteriorates quickly in another one third of this population (Blecker, Paul, Taksler, Ogedegbe, & Katz, 2013).

Heart failure is the leading cause of hospitalization in older adults, accounting for more than one million U.S. hospitalizations annually and contributing to an additional two to three million admissions (Go et al., 2014; Blecker et al., 2013). In 2007, older adults with heart failure accounted for 14 percent of the Medicare population yet consumed 43 percent of the Medicare budget, with much of the cost burden attributed to hospitalization (Linden & Adler-Milstein, 2008). The current medical cost of caring for heart failure patients in the U. S. is $32 billion annually and with the explosive growth of the older population is predicted to be more than $77 billion by 2030 (Heidenreich et al., 2011).

The compounding of physiologic events related to heart failure often causes a greater loss of physical function for the patient and they may require hospitalization.



Pages:   || 2 | 3 | 4 | 5 |   ...   | 14 |


Similar works:

«ASSESSMENT OF MITOCHONDRIAL STRESSORS ON CELLULAR BIOENERGETICS by BLAKE R. ZELICKSON VICTOR M. DARLEY-USMAR, COMMITTEE CHAIR JOHN C. CHATHAM YABING CHEN LOUIS J. DELL’ITALIA AIMEE LANDAR C. ROGER WHITE A DISSERTATION Submitted to the graduate faculty of The University of Alabama at Birmingham, in partial fulfillment of the requirements for the degree of Doctor of Philosophy BIRMINGHAM, ALABAMA 2011 ASSESSMENT OF MITOCHONDRIAL STRESSORS ON CELLULAR BIOENERGETICS BLAKE R. ZELICKSON MOLECULAR...»

«Interaction in a Hybrid Society: A Terminological Footnote Inga Tomic-Koludrovic1, Ivica Mitrovic2, Mirko Petric3 1 Department of Sociology Faculty of Philosophy, Zadar inga.tomic-koludrovic@umas.hr 2 Department of Computer Science Faculty of Electrical Engineering, Mechanical Engineering and Naval Architecture, Split ivica.mitrovic@umas.hr 3 Department of Visual Communication Design Arts Academy University of Split mirko.petric@umas.hr Glagoljaska bb 21000 Split, Croatia office@umas.hr...»

«EFFECTS OF DEFORESTATION AND RIPARIAN BUFFERS ON LOTIC COMMUNITIES IN SOUTHEASTERN COSTA RICA: IMPLICATIONS FOR BIODIVERSITY CONSERVATION IN TROPICAL STREAMS A Dissertation Presented in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy with a Major in Natural Resources in the College of Graduate Studies University of Idaho and in the Graduate School Centro Agronómico Tropical de Investigación y Enseñanza by Christopher M. Lorion December 2007 Major Professors:...»

«INSTITUCION EDUCATIVA DEPARTAMENTAL FIDEL CANO TENA CUNDINAMARCA MANUAL DE CONVIVENCIA ESCOLAR 2013 1 MANUAL DE CONVIVENCIA ESTRUCTURA PRESENTACION INTRODUCCION NOMBRE INSTITUCION LOGOTIPO SIMBOLOS MARCO LEGAL INSTITUCIONAL PRINCIPIOS CONSTITUCIONALES Y LEGALES OBJETIVOS GENERALES • ESPECIFICOS • CAPITULO I: FILOSOFIA INSTITUCIONAL MISION • VISION • PERFILES • CAPITULO II: DEL PROCESO DE MATRICULA REQUISITOS • ALUMNOS ANTIGUOS • ALUMNOS NUEVOS • CAPITULO III: DE LOS UNIFORMES...»

«Study of Hall Thruster Discharge Channel Wall Erosion via Optical Diagnostics by Wensheng Huang A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy (Aerospace Engineering) in The University of Michigan 2011 Doctoral Committee: Professor Alec D. Gallimore, Chair Professor Iain D. Boyd Associate Professor John E. Foster Lecturer Timothy B. Smith Hani Kamhawi, NASA Glenn Research Center © Wensheng Huang 2011 Acknowledgements My biggest thanks...»

«CONTEMPORARY RITUAL PRACTICE IN AN ABORIGINAL SETTLEMENT: THE WARLPIRI KURDIJI CEREMONY Georgia Curran School of Archaeology and Anthropology, Australian National University A thesis submitted in fulfilment of a Doctor of Philosophy in Anthropology, Australian National University June 2010 WARNING: The names of people who have recently died have been included in this thesis. This has been done solely so their contribution to the research can be recognised in the future. Please do not continue...»

«CASTLES AND LANDSCAPES: AN ARCHAEOLOGICAL SURVEY OF YORKSHIRE AND THE EAST MIDLANDS VOLUME I Thesis submitted for the degree of Doctor of Philosophy at the University of Leicester by Oliver Hamilton Creighton School of Archaeological Studies University of Leicester December 1998 UMI Number: U117043 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete...»

«AN Abstract OF THE THESIS OF for the degree of Doctor of Philosophy in Biochemistry Meredith L. Howell presented on May 15, 1992. and Biophysics Title: Vaccinia Virus Ribonucleotide Reductase: Regulation of the Gene Products and Characterization of the Recombinant Small Subunit Protein Redacted for Privacy Abstract approved: C. K. Mathews Ribonucleotide reductase is a remarkable enzyme that catalyzes the rate-limiting step in the synthesis of the 2'-deoxynucleoside triphosphates. The intent of...»

«THE EFFECT OF CEMENT MECHANICAL PROPERTIES AND RESERVOIR COMPACTION ON HPHT WELL INTEGRITY A Dissertation by ZHAOGUANG YUAN Submitted to the Office of Graduate Studies of Texas A&M University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Approved by: Co-Chairs of Committee, Jerome J. Schubert Catalin Teodoriu Committee Members, Gene Beck Paolo Gardoni Head of Department, A. Daniel Hill December 2012 Major Subject: Petroleum Engineering Copyright 2012...»

«SYSTEMS THINKING A Dissertation Presented to the Faculty of the Graduate School of Cornell University in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy by Derek Anthony Cabrera May 2006 © 2006 Derek Anthony Cabrera SYSTEMS THINKING Derek Anthony Cabrera, Ph.D. Cornell University 2006 This research set out to clarify the construct of systems thinking and to define it as a conceptual framework apart from systems science, systems theory, systems methods, and other...»

«DYNAMIC RESOURCE MANAGEMENT IN RESOURCE-OVERBOOKED CLOUD DATA CENTERS By Faruk Caglar Dissertation Submitted to the Faculty of the Graduate School of Vanderbilt University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY in Computer Science August, 2015 Nashville, Tennessee Approved: Dr. Aniruddha S. Gokhale Dr. Douglas C. Schmidt Dr. Gautam Biswas Dr. Christopher J. White Dr. Akos Ledeczi To my beloved wife Fatma for her patience, encouragement, and support...»

«Resource Sharing in Mobile Wireless Networks Maria Papadopouli Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Graduate School of Arts and Sciences COLUMBIA UNIVERSITY 2002 Resource Sharing in Mobile Wireless Networks Maria Papadopouli Advisor: Henning Schulzrinne Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Graduate School of Arts and Sciences COLUMBIA UNIVERSITY 2002 c 2002 Maria...»





 
<<  HOME   |    CONTACTS
2016 www.dissertation.xlibx.info - Dissertations, online materials

Materials of this site are available for review, all rights belong to their respective owners.
If you do not agree with the fact that your material is placed on this site, please, email us, we will within 1-2 business days delete him.