The Importance of Post-Discharge Exercise for Older Adults
After a hospital stay, older adults face a heightened risk of functional decline, falls, and re-hospitalization [1, 2]. Engaging in a structured exercise program is a proven way to counteract these risks, improving mobility, strength, and overall quality of life [1, 2]. However, participation rates are often low, highlighting the need to understand the complex array of influences affecting patients' decisions and abilities [1].
Personal Psychological and Behavioral Factors
An individual's mindset and history with exercise are powerful predictors of future engagement [1, 2]. Self-efficacy, a person's belief in their ability to succeed at a task, is particularly significant; higher self-efficacy regarding exercise correlates with greater engagement [1]. Low motivation and a lack of prior exercise habits are common barriers [1, 2]. Conversely, those with a regular exercise routine before hospitalization are more likely to continue exercising post-discharge [1]. A patient's perception of the risk of serious injury from a fall can also motivate participation in preventative exercises [1].
Social Support and Environmental Influences
An older patient’s environment and social network are critical [1, 2]. Living with a partner is a strong predictor of exercise engagement, as partners can provide encouragement and accountability [1]. Family and friends also offer support, helping with motivation and logistics like transportation [1, 2].
The Role of Healthcare Providers and Program Delivery
The way exercise is recommended and delivered can significantly impact participation [1, 2]. A strong recommendation from a healthcare provider, such as a physiotherapist or physician, makes patients nearly twice as likely to engage in exercise [1]. Program structure also matters; offering a choice between group-based and home-based programs can cater to different needs and preferences [1, 2]. The physical accessibility of the home and community facilities is a major barrier; reduced home accessibility is a predictor of non-participation [1, 2].
Medical and Functional Factors
Beyond psychological and social aspects, a patient's physical state is a primary determinant of exercise capacity [1, 2]. Higher levels of functional ability at discharge are associated with greater exercise engagement [1]. Medical problems like chronic pain are frequently cited barriers [1, 2]. The presence of chronic illnesses and poor nutritional status can also complicate or hinder participation [1, 2].
Comparison of Barriers and Facilitators
| Factor Type | Barriers to Engagement | Facilitators of Engagement |
|---|---|---|
| Personal | Low self-efficacy, low motivation, fear of falling, poor nutrition, no prior exercise habit [1, 2] | High self-efficacy, internal motivation, perceived risk of severe injury from falling, prior exercise habit [1] |
| Social | Living alone, lack of family support, caregiver protection leading to inactivity [1] | Living with a partner, active family involvement, peer encouragement [1, 2] |
| Medical | Pain, multiple chronic conditions, reduced functional ability [1, 2] | Good functional ability at discharge, effective pain management [1, 2] |
| Programmatic | Poor home accessibility, lack of clear program information, limited access to equipment [1, 2] | Healthcare provider recommendation, choice of home or group programs, tailored exercise instruction [1, 2] |
Overcoming Barriers with Tailored Interventions
To increase exercise participation, interventions must be personalized [1]. Patients with low self-efficacy may benefit from motivational counseling and supervised sessions [1]. Those with pain require effective management strategies and adapted exercises [1]. Home-based programs can address accessibility, and social support can be enhanced by involving family or offering group options [1, 2]. Evidence-based programs, such as those recommended by the National Institute on Aging, can be adapted [2]. Healthcare providers should recommend exercise and connect patients with accessible, structured programs addressing specific barriers [1, 2].
Conclusion
Understanding what factors associated with older patients engagement in exercise after hospital discharge reveals a complex interplay of personal, social, and medical influences [1, 2]. Addressing low self-efficacy, leveraging social support, and tailoring programs to manage medical barriers are key to improving recovery and long-term health [1, 2]. A holistic, personalized approach is essential for transforming post-hospital exercise into a consistent, beneficial reality for older patients [1, 2].
