1. Objective Assessment of Activity Levels in Hospitalized Older Patients with Wrist Actigraphy: Correlation with Medical Illness Burden Aguila N., 1 Gooneratne N.S., 1,2 Roque R., 1 Marie E., 1 Gehrman P., 2,3 Richards K. 4 Nova Aguila, MD Geriatric Fellow

2. Introduction Several methods exist to measure medical illness burden in hospitalized patients. These generally require chart abstraction with review of lab data to derive an illness score. Patient movement and activity levels may be able to provide this information.

3. Introduction Activity data can objectively be collected using an actigraph. Actigraphy is an objective and non invasive method to estimate disturbances in human sleep-wake rhythms.

4. Introduction Actigraph, small and light device, is strapped onto the patient’s wrist or ankle. This detects movement throughout day and night without interfering with patient’s normal activities

5. Introduction Our study is a pilot study seeking to investigate the possible association of activity and medical illness burden in elderly patients admitted to the Penn Presbyterian Medical Center - Acute Care for Elders Unit (ACE).

6. Study Methods This study was conducted as part of a larger on- going study of the relationship between rest- activity rhythms and incident delirium in older adults. O Our primary hypothesize is that there exists an inverse relationship between activity count and medical illness burden.

7. Study Methods  65 y/o patients admitted at ACE unit ( N = 6) Actigraphy monitoring Retrospective chart review ( Cumulative Illness Rating Score – CIRS)

8. Study Methods The CIRS has previously been validated as an indicator of medical illness burden. The physician abstracting the CIRS data was blinded to the actigraphy findings.

9. Results Statistical Analysis: Due to the non-parametric distribution of the data, Spearman rank correlation coefficients were calculated to compare the association between wrist activity counts and the CIRS score.

10. Results Sample Actogram

11. Results Correlation between activity counts and CIRS score

12. Results Sample Actogram

13. Results Correlation between activity counts and CIRS score

14. Discussion

15. Discussion Wrist activity monitors may represent a low cost, easy to implement tool that provides valuable insights into a patient’s overall medical condition during an acute hospitalization. Further research is needed to determine optimal cut-points for important clinical outcomes, such as mortality.

16. Nagaratnam N, Gayagay G, Jr. Validation of the Cumulative Illness Rating Scale (CIRS) in hospitalized nonagenarians. Archives of Gerontology and Geriatrics 2007; 44 (1):29-36. Nagels G, Engelborghs S, Vloeberghs E et al. Correlation between actigraphy and nurses' observation of activity in dementia. International Journal of Geriatric Psychiatry 2007; 22 (1):84-6. References