The interplay between patients' and family members' attitudes toward mobility and actual mobility in hospitalized older adults

BACKGROUND: Reduced mobility during hospitalization is a significant clinical challenge for older adults, contributing to functional decline. Grounded in Bandura's Social Cognitive Theory (SCT), which posits that personal factors and social environment interact dynamically to shape behavior, this study examined the interplay between patients' and family members' attitudes toward in-hospital mobility as factors of actual mobility in hospitalized older adults. METHODS: A prospective cross-sectional observational study included 140 dyads of older adult patients (≥65 years) and their family members across four hospitals in northern Israel. Attitudes toward mobility were assessed using the Attitudes Towards Mobility during Hospitalization (ATM-H) scale. Mobility was measured objectively (step count via ActiGraph accelerometers) and subjectively (self-reports). Structural equation modelling (SEM) was employed to analyze relationships among variables. RESULTS: SEM analysis revealed that patient attitudes significantly associated with in-hospital mobility (β=.192, p=.023). Family attitudes were related to patient mobility indirectly through patient attitudes (β=.043, p=.01). Independence in activities of daily living was associated with more positive patient attitudes. Older age and lower education among family members were associated with more hesitant attitudes toward mobility. CONCLUSION: Both patient and family attitudes are modifiable factors of in-hospital mobility. Tailored interventions should actively engage both older patients and their families in mobility promotion, with particular attention to less independent older adults and older, less educated family members. These findings highlight the value of family-inclusive approaches in geriatric nursing practice.