Geriatric evaluation and management inpatients spend little time participating in physically, cognitively or socially meaningful activity: a time–motion analysis

Abstract

Background Geriatric Evaluation and Management (GEM) services provide subacute care for older adults with complex conditions. Meaningful activities are important for preventing functional decline in hospitalised older adults; however, no studies have evaluated GEM inpatients’ participation in such activities. Objective To determine the proportion of time GEM inpatients spend performing meaningful activities during the day and investigate whether ward environments and day of the week are associated with activity levels. Method This observational study used behavioural mapping to audit inpatients across three GEM wards. Observations were made at 10-minute intervals over 12 consecutive hours on weekdays and 10.5 hours on weekend days. Activities were categorised as physical, cognitive or social. Logistic mixed models were used to analyse factors associated with engagement in meaningful activities. Results In total, 60 030 minutes were observed among 70 inpatients. Overall, GEM inpatients spent 16%, 6% and 18% of observed time in physically, cognitively and socially meaningful activities, respectively. Weekend days were associated with higher odds of cognitive engagement (OR 4.79, 95% CI 1.71–13.41, P = .003) but lower odds of social engagement (OR 0.57, 95% CI 0.38–0.85, P = .006). Time spent outside patients’ rooms was positively associated with all types of meaningful activities. The odds of physically meaningful activity were not found to vary between weekends and weekdays. Conclusions GEM inpatients demonstrate lower engagement in meaningful activities compared to rehabilitation contexts. The positive association between activity levels and time spent outside patients’ rooms emphasises the importance of accessible communal areas. Interventions to promote active participation are needed in inpatient GEM settings.