Activity-tracking technology could help older inpatients return home sooner

Research led by Hamilton Health Sciences (HHS) respirologist Dr. Mylinh Duong could prove that movement is the best medicine for frail, elderly patients recovering from illness in hospital.

Duong is partnering with HHS patients for studies aimed at developing artificial intelligence (AI) technology to get older patients moving during hospital stays. It’s a collaborative project between HHS and the McMaster Institute for Research on Aging, and was funded by the Labarge Centre for Mobility in Aging. Duong’s research could benefit patients locally, and worldwide.

“The goal is to develop an AI device to help better understand the type of activities needed to maintain muscle strength and mobility, especially during times of acute illness.”

This team approach also includes nurses, physiotherapists, kinesiology researchers and McMaster University software programmers.

As part of this research, Duong recruited 50 inpatients from medical wards at HHS Juravinski Hospital and Cancer Centre (JHCC) for a one-year pilot study that wrapped up in 2023. These patient volunteers, aged 75 years and older, wore activity tracking devices 24/7, for up to seven days while in hospital.

“During that time we were monitoring their activity level continuously,” says Duong.

The pilot focused on finding out how willing patients would be to wear a tracking device around the clock. In fact, they wore three — on their wrist, ankle and thigh — and at the end of the study they were asked which area of the body was the most comfortable for wearing the device. The pilot also looked at how well the trackers worked based on where on the body they were situated, and how securely they stayed on.

“Patients really loved the trackers and showed a great deal of interest in the study.”  

Results are being compiled for a peer-reviewed publication, and the next phase of Duong’s work will be a much larger study involving JHCC and HHS Hamilton General Hospital inpatients. Data collected during this larger study will lay the groundwork for developing a customized wearable device that uses AI technology to assess patients and customize plans for mobility during hospital stays.

“We want to collect data across a huge range of patients admitted to hospital once they are medically stable, to better understand, through tracking, the type of activity they’re doing in hospital and whether they maintain their fitness level, improve or become weaker,” says Duong.

“The goal is to develop an AI device to help better understand the type of activities needed to maintain muscle strength and mobility, especially during times of acute illness. This technology would help care teams measure and monitor patients’ activity during hospital stays and provide feedback on the type and amount of activity needed to maintain muscle strength.”

Too much bedrest

Research from the United States and Europe found that older hospital patients spend more than 95 per cent of their time in their bed, says Duong.

The question we want to answer is, ‘What will it take to keep these patients mobile while in hospital, and keep up their strength, so they don’t lose any of this during their stay?”

“Every day a patient spends in bed, they lose up to five per cent of their muscle mass. So it’s not surprising that you can barely get someone out of bed and walking by the time they’re medical stable and ready for discharge. The question we want to answer is, ‘What will it take to keep these patients mobile while in hospital, and keep up their strength, so they don’t lose any of this during their stay?”

Over the years, a much older population has been getting admitted to hospital, and they’re often frail due to multiple medical conditions and the severity of their illness, says Duong. But once their illness is taken care of and they’re stable, they often can’t be discharged because they’re too frail after weeks of being hospitalized and away from their daily routines.

This, in turn, creates a backlog of inpatients who are medically ready to be discharged but can’t leave the hospital due to frailty. This backlog contributes to staffing and bed shortages. And their mobility may have deteriorated so much during their hospital stay that they now need long-term care, and become alternative-level-of-care patients waiting in hospital for a long-term care bed to open up in the community.

Encouraging movement

The JHCC nursing teams played a huge role in making the pilot study a success by developing a plan to help patients become mobile, sooner. For example, patients were evaluated by members of their care team daily to see if they were ready to have catheter or IV lines removed, making it easier for them to get out of bed. Since the hospital didn’t have enough physiotherapists to ramp up what was already being done to help patients move more, the hospital’s physiotherapy team developed a simple and safe program where nurses could assess patients and help them get slowly and safely out of bed, and on their feet.

Welcome opportunities to participate

Older patients are often excluded from trials for reasons including age or other existing health issues, but Duong’s studies give them opportunities to take part in leading-edge research into innovative technologies aimed at helping them maintain their quality of life.

“Our 50 patient volunteers were true champions of this project.”

“We wanted real world studies that truly capture typical patients on our medical wards,” says Duong. “These are patients who may have multiple conditions and are vulnerable to adverse effects of a hospital stay such as too much bedrest.”

Patients were keen to volunteer for the pilot, even though it meant wearing three devices, constantly, for several days. “There was a very high acceptability rate,” says Duong. “Patients reported to us that they didn’t mind wearing the devices. In fact, patients really loved the trackers and showed a great deal of interest in the study. Our 50 patient volunteers were true champions of this project.”

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