Physiologic Responses to Simulated Care Activities in Older Surgical Patients

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DESCRIPTION (provided by applicant): The importance of preserving physical function during hospitalization, especially for adults aged 65 and older, is so well acknowledged that clinical care activities such as turning and ambulating are part of routine hospital ward care. However, physical functioning has not been promoted as much in the intensive care unit (ICU). Regardless of the patient's primary disease, even short periods of bed rest can reduce functional capacity. Consequently, clinical care activities that maintain physical function should be a priority even in the ICU. The chronically critically ill, defined as patients who require ICU care for weeks to months, are par- 'ticularly vulnerable to physical deconditioning and are often older, frequently postoperative, and at high risk for mortality, morbidity, and hospital readmissions. This descriptive feasibility study will apply an innovative, clinically relevant, noninvasive approach to measure clinical care activities in a simulated ICU setting using existing technology with a population of potential ICU elders as a first step towards systematically evaluating activity patterns and developing activity interventions for the critically ill. This study aims to evaluate the utility of using the ActiHeart(tm), a type of actigraph that measures motion and heart rate simultaneously, to measure simulated clinical care activities with older adults prior to their hospitalization for elective surgery. This population has been targeted because surgical patients represent a significant proportion of older ICU patients and are at high risk for both chronic critical illness and bed rest. The study's specific aims include: Aim 1- Describe the patterns of motion and heart rate during five different clinical care activities (turning, dangling, transferring, chair sitting, and ambulating); Aim 2-Compare clinical care activities using motion and continuous heart rate data to discriminate activity levels between five different clinical care activities; and Aim 3-Explore age, pain, functional performance and status, and morbidity as covariates of motion and heart rate data during the simulation of clinical care activities. If feasible, the results would lay the foundation for the ActiHeart's(tm) use in the ICU setting, where many additional confounding variables exist. The study will begin a program of research aimed at optimizing physical function in hospitalized elders, especially the chronically critically ill. This proposal addresses three of the National Institute of Nursing Research (NINR) strategic objectives: integrating biological and behavioral science, adopting and adapting new technologies, and improving nursing science methods. This focus on health promotion and disease prevention, increasing the potential for recovery and limiting disability in older chronically critically ill patients, represents a core value of nursing and public health, identified as one of NINR's four research areas of opportunity.