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.

Objectives: To explore the effects of four types of support (psychological support, instrumental support, supervision of instrumental support, and explanation of medical care) on the level of depressive symptoms among hospitalized older adults. Method: The sample consisted of 468 older adults admitted to the internal medicine units of a large tertiary care medical center in northern Israel. Respondents filled out self-report questionnaires upon admission and discharge. Information regarding severity of illness, chronic health status, and length of hospital stay was gathered from their medical records. Multivariate regression was used to test the association between the four types of caregiving support and depressive symptoms. Results: Psychological support from informal caregivers was found to be negatively related to depressive symptoms, and instrumental support to be positively related to depressive symptoms among respondents who were more independent in their functioning before the hospitalization. These relationships remained significant after controlling for previously-identified precursors of depressive symptoms: age, gender, education, widowhood, functional and cognitive status, severity of illness, co-morbidities, and length of hospital stay. Supervision of instrumental support and explanation of medical care were not related to depressive symptoms. Conclusion: Results of this study suggest that functional status, the kind of support, and the setting in which it is given are important in understanding the influence of informal support on the well-being of older adults. The potentially positive as well as negative consequences of various types of support in the hospital setting should be recognized and addressed.

ABSTARCT Objectives: The present study investigates the applicability of the behavioral model of health service use (Andersen, 1995) to the predicting of psychotherapy use among older adults. Methods: Sample was obtained, using a random-digit dialing methodology, from the older Jewish population in Israel. The final sample consisted of 509 respondents with an average age of 74.08 (SD = 5.89). The telephone interviews were conducted in the first week of August 2011, by experienced interviewers, in Hebrew or Russian, using a structured questionnaire. Results: After adjusting for age, gender, education, marital status, religiosity, health status, and economic status in the first step, binary logistic regression revealed that higher depressive symptoms, positive attitudes toward psychological treatment, primary physician referral, and accessibility of psychological services were all related to higher odds ratios for seeking psychological treatment. Conclusions: The present study integrated previously identified precursors of mental health service use into one model predicting psychotherapy use among community-dwelling older adults. The model suggests that the point of entry to psychotherapy is not limited to one source and that individuals’ need, their attitudes, accessibility of services, and their primary physicians’ referral are all useful facilitators of psychotherapy use.