Among the common problems related to aging is sleep quality; over half of older adults suffer from symptoms of insomnia. Age-related changes in circadian sleep/wake regulation constitute a major underlying factor. Constant and organized lifestyle may moderate the effects of circadian rhythm changes on sleep. Preliminary findings have linked daily regularity to sleep quality among healthy adults and in patients with Parkinson disease. The current study investigated the relationships between daily routines and sleep quality among community dwelling elderly. Ninety-six Israeli Russian-speaking elderly living in a retirement community (mean age 75 ±13.88, 72% women, 82% living alone) participated. Routines were assessed with the Scale of Older Adults Routine (SOAR) by a trained interviewer at 3 time points 2 weeks apart. A subsample (n = 33) completed the Social Rhythm Metric (SRM) 2-week diary. Sleep quality was evaluated using the Pittsburg Sleep Quality Index (PSQI). Daily Functional status was assessed with the Lawton Instrumental Activities of Daily Living (IADL). Mean sleep efficiency was 78%, functional status was fairly good (mean IADL 45 of 50 [SD = 6.12]). Regression analyses indicated that increased stability in daily routine, as measured by the SOAR for the entire sample, predicted shorter sleep latency, higher sleep efficiency and improved sleep quality, beyond functional status, comorbidities, and age. Similar associations were found for the subsample using the SRM. Maintenance of daily routines is associated with a reduced rate of insomnia in the elderly. Further studies should examine these relations in broader populations with regard to health, functional status, and cultural background.

Background: In-hospital immobility of older adults is associated with hospital-associated functional decline (HAFD). This study examined the WALK-FOR program’s effects on HAFD prevention. Methods: A quasi-experimental pre-post two-group (intervention group [IG] n = 188, control group [CG] n = 189) design was applied in two hospital internal medical units. On admission, patients reported pre-hospitalization functional status, which was assessed again at discharge and 1-month follow-up. Primary outcome was decline in basic activities of daily living (BADL), using the Modified Barthel Index. Secondary outcomes were decline in instrumental ADL (Lawton’s IADL scale) and community mobility (Yale Physical Activity Survey). All participants (75.1 ± 7 years old) were cognitively intact and ambulatory at admission. The WALK-FOR included a unit-tailored mobility program utilizing patient-and-staff education with a specific mobility goal (900 steps per day), measured by accelerometer. Results: Decline in BADL occurred among 33% of the CG versus 23% of the IG (p = .02) at discharge, and among 43% of the CG versus 30% in the IG (p = .01) at 1-month follow-up. Similarly, 26% of the CG versus 15% of the IG declined in community mobility at 1-month follow-up (p = .01). Adjusted for major covariates, the intervention reduced the odds of decline in BADL by 41% (p = .05) at discharge and by 49% at 1-month follow-up (p = .01), and in community mobility by 63% (p = .02). There was no significant effect of the intervention on IADL decline (p = .19). Conclusions: The WALK-FOR intervention is effective in reducing HAFD.

There is growing evidence that mobility interventions can increase in-hospital mobility and prevent hospitalization-associated functional decline among older adults. However, implementing such interventions is challenging, mainly due to site-specific constraints and limited resources. The Systems Engineering Initiative for Patient Safety (SEIPS 2.0) model has the potential to guide a sustainable, site-tailored mobility intervention. Thus, the aim of the current study is to demonstrate an adaptation process guided by the SEIPS 2.0 model to articulate site-specific, culturally based interventions to improve in-hospital mobility among older adults. Six consecutive phases addressed each of the model’s elements in the research setting. Phase-1 aimed to determine a measurable outcome: steps/d, measured with accelerometers, associated with functional decline. Phase-2 included interviews with key persons in leadership positions in the hospital to explore organizational factors affecting in-hospital mobility. Phases-3 and 4 aimed to identify attitudes, knowledge, barriers, and current behaviors of medical staff (n = 116) and patients (n = 203) related to patient mobility. Phase-5 included four focus-groups with unit staff aimed at developing an action plan while adapting existing intervention strategies to site needs. Phase-6 relied on a steering committee that developed intervention-adaptation and implementation plans. Nine hundred steps/d was defined as the intervention outcome. 40% of patients walked fewer than 900 steps/d regardless of capability. Assessing or promoting mobility did not exist as a separate task and thus was routinely overlooked. Several barriers to patients’ mobility were identified, specifically limited knowledge of practical aspects of mobility. Consequently, staff adopted practical steps to address them. Nurses were designated to assess mobility, and nursing assistants to support mobility. Mobility was defined as a quality indicator to be documented in electronic medical records and closely supervised by hospital and unit management. Preliminary analyses of the “Walk FOR” protocol demonstrates its’ ability to reduce barriers, to re-shape staff attitudes and knowledge, and to increase in-hospital mobility of older adults. The SEIPS-2.0 model can serve as a useful guide for implementing a site-tailored comprehensive mobility intervention. This process, which relies on local resources, may promise sustainable practice change that may support early effective rehabilitation and recovery.

The functional changes that occur immediately before acute hospitalization and those that occur during hospitalization are pertinent to posthospitalization functional status in older adults. Our primary aim was to estimate the effects of membership in categories that take into account pre- and within-hospital functional changes on the likelihood of functional recovery (FR) 1 month after discharge. The sample included 691 older (≥70) adults admitted to general-medical inpatient units in two hospitals in Israel. FR was defined as a restoration of functioning 1 month postdischarge to levels reported 2 weeks prior to admission. Patients were classified according to functional decline or stability during the prehospital stage and decline, stability, or improvement between admission and discharge in terms of ability to perform self-care or mobility activities. We performed multivariate logistic regressions to test the association between categories of functional change and FR. Patients who remained stable before and during hospitalization had the highest odds of maintaining their premorbid functional levels. Those who experienced functional improvement during hospitalization, despite previous functional loss, were 2.3–2.9 times more likely than persistent decliners to experience FR (p < .05 for all). Comparable patterns were found in the relationship between pre- and in-hospital functional trajectories and recovery, both in self-care and in mobility. Differentiating between pre- and in-hospital functional changes is important for promoting short-term posthospitalization FR. In-hospital function-focused care that takes into account preadmission functional history may help improve posthospitalization FR.