What mobility factors are critical to include in a comprehensive mobility discharge assessment framework for older adults transitioning from hospital-to-home in the community? An international e-Delphi study

Abstract

Purpose

To prioritize and achieve consensus on mobility determinant factors [cognitive, financial, environmental, personal, physical, psychological, social] considered critical to include in the COmprehensive Mobility Discharge Assessment Framework (COMDAF) for older adults transitioning from hospital-to-home.

Materials and methods

We conducted a three-round modified e-Delphi process with 60 international experts (seven older adults, nine family caregivers, 24 clinicians, and 20 researchers) from nine countries with universal or near-universal health coverage. Expert members rated 91 factors identified from scoping reviews using a 9-point scale: not important (1-3), important (4-6), and critical (7-9).

Result

A total of 41 of 91 factors (45.1%) met the a-priori consensus criterion after three rounds: five cognitive, five environmental, two personal, 19 physical, six psychological, and six social factors. No financial factors reached a consensus. The older adult steering committee member recommended the addition of two environmental factors, resulting in 43 mobility factors included in the COMDAF.

Conclusions

We advanced a comprehensive mobility framework by developing, through consensus, 43 mobility factors to be assessed as part of a COMDAF. However, its use in hospital-to-home may not be feasible. Therefore, future research will determine the core mobility factors for COMDAF and which measurement instruments best measure these factors.

Relevance

An interdisciplinary discharge rehabilitation team can utilize the COMDAF during hospital-to-home transition.

Implications for rehabilitation

• Mobility assessment following a hospital discharge is a complex process requiring an interdisciplinary discharge rehabilitation team.

• This study provided a comprehensive list of 91 factors across all seven mobility determinants (cognitive, environmental, financial, personal, physical, psychological, and social) for clinicians in other care settings to use as a starting point to determine which mobility factor should be assessed during older adults’ hospital-to-home transition.

• This international e-Delphi study identified 43 factors within mobility determinants (cognitive, environmental, personal, physical, psychological, and social) to be included in a Comprehensive Mobility Discharge Assessment Framework to assess older adults’ mobility during the hospital to home transition.

• Using these 43 factors, clinicians can identify which assessment tool is best suited to assess the factors while reflecting on the logistics and feasibility; this is the next phase of this project

Keywords:

• Mobility
• ageing
• discharge
• hospital-to-home
• e-Delphi process

Acknowledgment

The authors acknowledge the older adult and family caregiver steering committee members: Mr. John Fielding, Mrs. Dianne Fielding, Daniel Rayner, and all the expert members who participated in this e-Delphi rounds. This work was conducted as part of Michael Kalu’s PhD thesis [Rehabilitation Science Program. School of Rehabilitation Science, McMaster University, Hamilton, Ontario Canada]. Michael Kalu received Mobility Labarge Scholarship from McMaster Institute for Research in Ageing, McMaster University, Hamilton, Ontario, Canada.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Available data for this project are attached as Appendices.

Additional information

Funding

Michael Kalu received Mobility Labarge Scholarship from McMaster Institute for Research in Ageing, McMaster University, Hamilton, Ontario, Canada.