Preventing Hospital-Associated Disability: Effects of the Hospital Early Structured Mobilization (HESM) Program on Function and Survival in Older Adults

Abstract Background Hospital-associated disability is common in older medical inpatients. Evidence for structured early mobilization pathways remains limited. Aim To evaluate whether the Hospital Early Structured Mobilization (HESM) pathway was associated with improved functional outcomes and 90-day survival. Design Single-centre quasi-experimental before-and-after cohort study. Methods We included 600 discharged-alive patients aged ≥ 65 years admitted to an internal medicine ward in Italy, 300 before and 300 after HESM implementation. HESM was an interdisciplinary, protocolised early mobilization pathway integrated into routine care. The primary outcome was clinically meaningful functional worsening at discharge, defined as an increase of ≥ 1 point in modified Rankin Scale and/or a decrease of ≥ 20 points in modified Barthel Index. Ninety-day mortality and safety were assessed using multivariable logistic and Cox regression. Results Functional worsening occurred in 149/300 patients before and 89/300 after implementation (49.7% vs 29.7%; absolute risk reduction 20.0 percentage points, 95% CI 12.3–27.7; number needed to treat 5). Modified Rankin Scale worsening decreased from 46.3% to 27.3%, and Barthel Index decline from 25.0% to 15.3%. HESM was associated with lower odds of functional worsening (adjusted OR 0.46, 95% CI 0.32–0.65). Ninety-day mortality decreased from 20.7% to 11.7% and remained lower after adjustment (HR 0.53, 95% CI 0.35–0.80). Falls were infrequent and similar. Conclusions HESM was associated with less functional decline and lower 90-day mortality. These findings support mobility-focused care pathways, although residual confounding cannot be excluded.