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.
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