Abstract
Hospital-acquired disability and delirium can be reduced by improving inpatient care practices to support mobility and independence, nutrition and hydration, and meaningful cognitive engagement for older inpatients. The challenge is translating this evidence into practice in all wards caring for older patients. Eat Walk Engage is a unique ward-based program using the i-PARIHS implementation framework to guide sustainable practice change. A skilled facilitator works with the multidisciplinary ward team to prioritise and tailor strategies to the recipients (patients, staff) and context of each ward. Multiple data sources and iterative team discussions build shared understanding of barriers and enablers. Pilot before-after studies have shown reductions in delirium, functional decline, falls and pressure injury, and length of stay. The program has been successfully scaled up to 8 medical, surgical and oncology wards in one large teaching hospital, and transferability is being tested in a cluster RCT across 4 hospitals.