Seniors are leaving this Ottawa hospital in better shape than before

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Marion Wright spent three excruciating hours alone on the floor last November after falling in her home. Unable to get up, she slowly dragged herself to her desk, but couldn’t reach her phone to call for help. She gave up after several painful attempts.

Finally, her granddaughter arrived and got help.

When Wright arrived at Queensway Carleton Hospital, she learned she had fractured her pelvis in multiple places. She immediately began to wonder what her future would hold.

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“I couldn’t move, I was completely immobilized, I was thinking, my goodness this is really bad. It made me feel older than I am.”

That changed after a few days when members of the hospital’s Get Moving team began working with her. They taught her how to sit up, how to slowly get out of bed, how to stand with the use of a walker and how to move around. They helped her walk through the hospital hallways several times a day using a walker. They taught her exercises she could do in bed. They showed up every day and helped her to see a path back to independence.

“I could not have literally got moving without them.”

Today, Wright is back home, independent and busy, walking without assistance, attending aquafit classes and continuing to work.

She is among current and former patients singing the praises of the Get Moving program which was introduced at the hospital in late 2022.

Since it began, Queensway Carleton has seen a stunning improvement in some high-risk patients’ functional independence and mobility during hospital stays. Some patients are leaving the hospital in better condition than when they arrived as a result of the program that promotes better recovery through movement.

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“They are incredible,” Wright said of the therapists and health workers who are part of the Get Moving team. “They are there every day, seven days a week, which is amazing. Without them, I don’t think I would have recovered anywhere near as well.”

Pelvic fractures are particularly dangerous for older adults, increasing a patient’s risk of long-term physical disability and even death.

Hospital stays have long been associated with reduced mobility and deconditioning because of prolonged inactivity, especially for seniors. For every day in bed, it can take days to regain lost muscle mass and mobility. Sometimes seniors who were mobile when they entered leave the hospital unable to walk.

That kind of outcome from a hospital stay for even a fairly minor ailment can change the course of an elderly person’s life, by making it more difficult for them to live independently, for example.

Queensway Carleton’s program aims to change that trajectory for high-risk patients.

Since it began in November 2022, it has helped more than 1,200 patients throughout the hospital by providing mobility training and encouraging them to move more. In addition to walks and movement during the day, program staff members make sure patients are out of bed for all their meals and get to the bathroom themselves, with assistance. The team members work throughout the hospital between 7 a.m. and 7:30 p.m.

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The interventions have reduced lengths of hospital stays, improved the patients’ health outcomes and are getting high marks from many patients and their families.

The hospital has tracked the program’s impact with something called the functional independence measure, which measures the patient’s level of disability and need for assistance with activities of daily living. On average, the hospital has seen an improvement from initial assessment to discharge for all functional independence measure scores. The most significant improvement — a 3.4-point improvement on a seven-point scale — is in locomotion.

Patients say being helped, even coaxed, to keep moving is a confidence builder.

Wright said the activity helped her recover more quickly and get in better shape than she likely would have without it. It also improved her spirits by giving her a focus and social interactions. Crucially, it gave her a sense of control over her life that she briefly lost after the fall.

She believes she wouldn’t still be living independently without the support of the program.

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“I was so happy to see them. They encouraged me, supported me and taught me how to move.”

Queensway Carleton is one of several hospitals around the province with similar programs aimed at keeping patients mobile and as independent as possible while admitted. Queensway Carleton’s Get Moving team is not permanently funded, but the province is paying attention. Hospital officials say they are in close contact with Ontario Health and are optimistic the program will continue.

People 65 and older are part of the fastest growing age group in Canada, something that is having a profound impact on hospitals and other health institutions.

At Queensway Carleton, 29 per cent of emergency department visits are by people aged 65 and over but that age group makes up 62 per cent of all patients who are admitted to hospital from the emergency department. Shortening the length of their hospital stays and helping them retain and improve their mobility while in hospital could have a significant impact not only on individual lives, but also on overcrowding in the emergency department where there are often admitted patients on stretchers waiting for hospital beds to come free. The hospital has three long-term care homes and 15 retirement homes within its catchment area.

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The Get Moving program is part of Queensway Carleton’s focus on geriatric care, especially when it comes to keeping patients independent and preventing what is known as hospital-associated disability.

In 2017, Queensway Carleton became the second hospital in Ontario to introduce an acute care for the elderly (ACE) unit, which provides an elder-friendly environment for patients over 65 admitted through the emergency department, with multiple chronic health conditions and who are experiencing a decline in functional abilities.

The program, which focuses on the patient as a whole, emphasizes mobility and function to help patients maintain their independence and the ability to return home. Clocks on the walls and frequent contact with people throughout the day, along with regular movement, aim to help orient hospital patients and reduce rates of hospital-induced delirium.

During the pandemic, the unit, which has a large number of private rooms and negative pressure rooms (for isolation and infection control), served another need, becoming a dedicated COVID-19 unit. That status as a dedicated COVID unit was lifted a year ago, but the hospital continued to treat a large number of patients who required isolation.

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Now the hospital is reviving the unit’s original purpose and focusing on acute care for the elderly. That includes familiarizing a new generation of nurses hired since the pandemic with the philosophy of ACE.

The hospital has also introduced a new behaviour support program in its emergency department, led by Melissa Laroche, who is an RN and advanced practice nurse in geriatrics.

A key goal of the program is to see patients and their caregivers and assess them quickly to help ensure that they don’t deteriorate during the wait, Laroche said. The program focuses on dementia care and caregiver support.

The program aims to help health professionals see the whole picture when a dementia patient arrives in emergency, rather than simply treating one issue, Laroche said.

She said the hospital had heard back from caregivers praising the program for helping to relieve the stress of long emergency department waits and communicating that their loved ones were understood and in safe hands.

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