EVERY 2 HOUR TOILETING PLUS AMBULATION, UPPER EXTREMITY EXERCISES & F

住院期间卧床可能导致功能下降、跌倒发生率增加和尿失禁。频繁的辅助如厕，然后在可忍受的情况下进行短时间的散步和上肢运动，可能是改善与睡眠相关的条件和维持功能的理想方法。高达40%的住院跌倒与患者自己试图上厕所有关。频繁的辅助如厕可以降低住院跌倒的发生率和尿失禁的发生率。到目前为止，还没有研究评估过这种干预的效果。我们假设，与常规护理相比，每两小时如厕结合短暂散步，上肢运动和鼓励液体摄入将改善老年住院患者的功能，减少跌倒率，减少尿失禁的发生率。我们进一步假设该方案将具有成本效益（即执行干预所需的人员成本将低于由于以下相关成本的减少而节省的成本：foley导尿管、foley导尿管相关尿路感染、新发压疮、新发深静脉血栓、住院跌倒相关成本、物理治疗的使用、住院时间相关成本和出院后一个月的养老院使用成本）。本初步研究的目的是确定后续随机试验的可行性、初步数据和预计预算。在为期三周的试点中，我们将在一个医疗病房进行，我们将随机分配年龄在65岁及以上、预计住院时间在三晚或以上的患者进行干预或常规护理。如果患者不能走动，患有MRSA或VRE，或无法给予知情同意且没有护理人员提供知情同意，则将被排除在外。干预患者将接受(1)每隔两小时如厕到床边的马桶或浴室，然后(2)在轮椅后面短暂走动，直到容忍，然后(3)回到床上或椅子上，并进行简短的（1 - 2分钟）一系列上肢活动范围练习，然后(4)鼓励喝6盎司的水（直到下午6点）。干预将在醒着时每两小时进行一次，在夜间我们将省略短暂的散步、活动范围练习和液体摄入。对治疗不知情的评估员将收集有关入院和出院功能的信息。尿失禁将通过称重尿失禁垫来确定。图表将审查功能下降，跌倒和尿失禁的易感危险因素。图表也将审查与费用相关的因素，使用foley导尿管，院内foley相关的尿路感染，新的压疮和跌倒。

Bedrest during hospitalization may contribute to functional decline, an increased incidence of falls, and urinary incontinence. Frequent assisted toileting, followed by a short walk as tolerated and upper extremity exercises, may be an ideal way to ameliorate bedrest-associated deconditioning and maintain function. Up to 40% of in-hospital falls are associated with patients' self-attempts to toilet. Frequent assisted toileting may decrease the rate of in-hospital falls, and the incidence of urinary incontinence. To date, no studies have evaluated the effect of such an intervention. We hypothesize that every two hour toileting combined with a brief walk, upper extremity movements, and encouraged fluid intake will improve function, decrease the rate of falls, and decrease the incidence of urinary incontinence among older medical inpatients compared to usual care. We further hypothesize that the protocol will be cost-effective (i.e. cost of personnel required to perform the intervention will be less than the savings due to decreases in the following associated costs: foley catheters, foley catheter-associated urinary tract infections, new pressure ulcers, new deep venous thromboses, in-hospital falls-associated costs, utilization of physical therapy, length of stay associated costs, and nursing home utilization costs in the month after discharge). The purpose of this pilot study is to determine feasibility, preliminary data and projected budget for a subsequent randomized trial. For the three week pilot, which will occur on one medical ward, we will randomize patients aged 65 and older with anticipated hospital length of stay of three nights or more to intervention or usual care. Patients will be excluded if they are nonambulatory, have MRSA or VRE, or are unable to give informed consent and do not have a caregiver to provide informed consent. Intervention patients will receive (1) every two hour toileting to bedside commode or bathroom as tolerated, followed by (2) a short ambulation behind a wheelchair, to tolerance, followed by (3) return to bed or chair and a brief (one-two minute) series of upper extremity range of motion exercises, followed by (4) encouragement to drink six ounces of water (up to 6 PM). The intervention will occur every two hours while awake, and during the night we will omit the brief walk, range of motion exercises, and fluid intake. An assessor blinded to treatment will collect information regarding admission and discharge function, and falls. Urinary incontinence will be determined by weighing incontinence pads. Charts will be reviewed for predisposing risk factors for functional decline, falls and incontinence. Charts will also be reviewed for cost-related factors of foley catheter use, nosocomial foley-associated urinary tract infections, new pressure ulcers, and falls.