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Is objective mobility data associated with pharmacologic venous thromboembolism (VTE) prophylaxis use among hospitalized older adults?

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Date
2018-04-10
Authors
Pavon, Juliessa
Sloane, R
Pieper, Carl
Colon-Emeric, Cathleen
Gallagher, David
Cohen, Harvey
Hall, K
Morey, Miriam
McCarty, Midori
Ortel, Thomas
Hastings, Susan
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Abstract
Background: Clinical practice guidelines state that mobility is supposed to play an important role in determining use and duration of pharmacologic VTE prophylaxis. This study examines whether measured mobility levels relate to pharmacologic VTE prophylaxis use among hospitalized older adults. Methods: Prospective observational data from a sample of community-dwelling older adults aged ≥ 60 years, admitted to an academic hospital’s general medicine service. Inpatient mobility was objectively measured using ankle-mounted accelerometers from admission until discharge (or ≤ 7 days). Clinical and demographic factors, and pharmacologic VTE prophylaxis use was manually abstracted from the medical record. We performed descriptive statistics for daily mobility parameters (time spent in activity, sedentary time, and step counts) according to VTE risk stratification using a validated stratification tool (Padua Score) and prophylaxis use. Pearson’s correlation was used to determine the correlation of mobility measures with use and duration of VTE prophylaxis. Results: Among hospitalized older adults in this sample (N=65), 71% (n=46) were low risk for VTE occurrence, yet 62% (n=40) received pharmacological VTE prophylaxis during an average of 57% of their hospital stay (SD 46). Median time in activity was 65 minutes/day (IQR 40, 102; Range 5 – 289 mins/day). Median time spent in sedentary activity (awake but not moving) was 15 hrs/day (IQR 12, 17; Range: 3 – 20 hrs/day). Median total daily steps was 1370 (IQR 852, 2387; Range: 86 – 6134 steps/day). There was significantly greater sedentary time (16 hrs/day) for high risk patients compared to low risk patients (13 hrs/day) (p=0.02), but no differences in activity time or step counts. There were no detectable differences in mobility measures between those receiving and not receiving pharmacological VTE prophylaxis, and no significant correlations between mobility measures and duration of VTE prophylaxis. Conclusions: Among hospitalized older adults, use and duration of VTE prophylaxis did not differ by higher or lower mobility activity, suggesting that better mobility awareness is needed to guide appropriate pharmacological VTE prophylaxis use.
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Conference
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https://hdl.handle.net/10161/24127
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Scholars@Duke

Colon-Emeric

Cathleen Sellner Colon-Emeric

Professor of Medicine
Current research focuses on the epidemiology, prediction, and prevention of osteoporotic fractures in elderly persons, and in improving the quality of care delivered to residents in skilled nursing facilities. Ongoing projects include a large, administrative database study of osteoporosis screening in men, a randomized trial of different staff education strategies to improve fall prevention in nursing homes, and several clinical demonstration projects.
Gallagher

David Michael Gallagher

Associate Professor of Medicine
As Chief of Hospital Medicine programs at Duke University Health System (DUHS), my primary responsibility is leadership of a team of physician and administrative leaders that  positively impact the strategies, goals, and objectives of Hospital Medicine at our three hospitals. I am responsible for oversight of various programs that focus on excellence in clinical care, patient safety and quality, clinical education, and academics. I report to the DUHS Chief Medical Officer, General Internal
Hastings

Susan Nicole Hastings

Professor of Medicine
Morey

Miriam C. Morey

Professor in Medicine
The general focus of Dr. Morey's work is exercise and aging. All of her research examines how physical activity, exercise training, or physical fitness influence the physical functioning and/or pyschosocial quality of life of older adults. She directs a supervised hospital-based program for older adults, which is used to examine longitudinally the effects of exercise training on the musculoskeletal, articular, and cardiorespiratory systems. Furthermore, she has a number of studies that e
Pavon

Juliessa Pavon

Associate Professor of Medicine
Pieper

Carl F. Pieper

Professor of Biostatistics & Bioinformatics
Analytic Interests. 1) Issues in the Design of Medical Experiments: I explore the use of reliability/generalizability models in experimental design. In addition to incorporation of reliability, I study powering longitudinal trials with multiple outcomes and substantial missing data using Mixed models. 2) Issues in the Analysis of Repeated Measures Designs & Longitudinal Data: Use of Hierarchical Linear Models (HLM) or Mixed Models in modeling trajectories of multipl
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