Interventions to Mobilize Elderly Patients and Reduce Length of Hospital Stay.

For older people, and in particular frail older people, acute illness and hospitalization are associated with significant potential harm. One of the major drivers of iatrogenic harm in older adults is hospital-induced immobility, the so-called "pajama paralysis." Older people in hospital are often confined to bed even after their acute illness has improved; not only by physical factors such as potentially unnecessary urinary catheters and monitoring equipment but also by the culture often found in hospital of keeping patients in bed for most of the day. Bed rest is associated with sarcopenia, infections, and greater length of stay, and early mobilization of patients is often overlooked as an intervention, despite being inexpensive and effective. In this article we review the evidence of the harm of unnecessary immobilization and discuss the innovations that have been developed to encourage a cultural shift away from pajama paralysis and toward early mobilization of older people in hospital.