Article

Walking speed norms and several risk thresholds for poor health
outcomes have been published for community-dwelling older adults. It is unclear
whether these values apply to hospitalized older adults.
The purpose of this study was to determine the in-hospital walking speed threshold that best
differentiates walking-independent from walking-dependent older adults.
This was a cross-sectional study. METHODS: This study recruited a convenience
sample of 174 ambulatory adults aged 65 years and older who had been admitted to
a medical-surgical unit of a university hospital. The participants' mean (SD) age
was 75 (7) years. Fifty-nine percent were women, 66% were white, and more than
40% were hospitalized for cardiovascular problems. Usual-pace walking speed was
assessed over 2.4 m. Walking independence was assessed through self-report.
Several methods were used to determine the threshold speed that best
differentiated walking-independent patients from walking-dependent patients.
Approaches included a receiver operating characteristic (ROC) curve, sensitivity
and specificity, and frequency distributions. RESULTS: The participants' mean
(SD) walking speed was 0.43 (0.23) m/s, and 62% reported walking independence.
Nearly 75% of the patients walked more slowly than the lowest community-based
risk threshold, yet 90% were discharged home. Overall, cut-point analyses
suggested that 0.30 to 0.35 m/s may be a meaningful threshold for maintaining
in-hospital walking independence. For simplicity of clinical application, 0.35
m/s was chosen as the optimal cut point for the sample. This threshold yielded a
balance between sensitivity and specificity (71% for both). Limitations The
limitations of this study were the small size of the convenience sample and the
single health outcome measure. CONCLUSIONS: Walking speeds of older adults who
are acutely ill are substantially slower than established community-based norms
and risk thresholds. The threshold identified, which was approximately 50% lower
than the lowest published community-based risk threshold, may serve as an initial
risk threshold or target value for maintaining in-hospital walking independence.

Langue : ANGLAIS