Association of functional status and hospital-acquired functional decline with 30-day outcomes in medical inpatients: A prospective cohort study (original) (raw)
Related papers
Journal of the American Geriatrics Society, 2015
OBJECTIVES: To investigate the combined contribution of processes of hospitalization and preadmission individual risk factors in explaining functional decline at discharge and at 1-month follow-up in older adults with nondisabling conditions. DESIGN: Prospective cohort study. SETTING: Internal medicine wards in two Israeli medical centers. PARTICIPANTS: Six hundred eighty-four individuals aged 70 and older admitted for a nondisabling problem. MEASUREMENTS: Functional decline was measured according to change in modified Barthel Index from premorbid to discharge and from premorbid to 1 month after discharge. In-hospital mobility, continence care, sleep medication consumption, satisfaction with hospital environment, and nutrition intake were assessed using previously tested self-report instruments. RESULTS: Two hundred eighty-two participants (41.2%) reported functional decline at discharge and 317 (46.3%) at 1 month after discharge. Path analysis indicated that inhospital mobility (standardized maximum likelihood estimate (SMLE) = À0.48, P < .001), continence care (SMLE = À0.12, P < .001), and length of stay (LOS) (SMLE = 0.06, P < .001) were directly related to functional decline at discharge and, together with personal risk factors, explained 64% of variance. In-hospital mobility, continence care, and LOS were indirectly related to functional decline at 1 month after discharge through functional decline at discharge (SMLE = 0.45, P < .001). Nutrition consumption (SMLE = À0.07, P < .001) was significantly related to functional decline at 1 month after discharge, explaining, together with other risk factors, 32% of variance. CONCLUSION: In-hospital low mobility, suboptimal continence care, and poor nutrition account for immediate and 1-month posthospitalization functional decline. These are potentially modifiable hospitalization risk factors for which practice and policy should be targeted in efforts to curb the posthospitalization functional decline trajectory.
2014
OBJECTIVE: To determine whether functional status near the time of discharge from acute care hospitalization is associated with acute care readmission. PATIENTS AND METHODS: Retrospective cohort study of 9405 consecutive patients admitted from an acute care hospital to an inpatient rehabilitation facility between July 1, 2006 and December 31, 2012. Patients' functional status at admission to the rehabilitation facility was assessed by the Functional Independence Measure (FIM) score, and divided into low, middle, or high functional status. The main outcome was readmission to an acute care hospital within 30 days of acute care discharge (for all patients and by subgroup according to diagnostic group: medical, orthopedic, or neurologic). RESULTS: There were 1182 (13%) readmissions. FIM score was significantly associated with readmission, with adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for low and middle versus high FIM score category of 3.0 (2.5-3.6; P < 0.001) and 1.5 (95% CI: 1.3-1.8; P < 0.001), respectively. This relationship between FIM score and readmission held across diagnostic category. Medical patients with low functional status had the highest readmission rate (OR: 29%; 95% CI: 25%-32%) and an adjusted OR for readmission of 3.2 (95% CI: 2.4-4.3, P < 0.001) compared to medical patients with high FIM scores. CONCLUSIONS AND RELEVANCE: For patients admitted to an acute inpatient rehabilitation facility, functional status near the time of discharge from an acute care hospital is strongly associated with acute care readmission, particularly for medical patients with greater functional impairments. Reducing functional status decline during acute care hospitalization may be an important strategy to lower readmissions.
Association of impaired functional status at hospital discharge and subsequent rehospitalization
Journal of Hospital Medicine, 2014
OBJECTIVE: To determine whether functional status near the time of discharge from acute care hospitalization is associated with acute care readmission. PATIENTS AND METHODS: Retrospective cohort study of 9405 consecutive patients admitted from an acute care hospital to an inpatient rehabilitation facility between July 1, 2006 and December 31, 2012. Patients' functional status at admission to the rehabilitation facility was assessed by the Functional Independence Measure (FIM) score, and divided into low, middle, or high functional status. The main outcome was readmission to an acute care hospital within 30 days of acute care discharge (for all patients and by subgroup according to diagnostic group: medical, orthopedic, or neurologic). RESULTS: There were 1182 (13%) readmissions. FIM score was significantly associated with readmission, with adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for low and middle versus high FIM score category of 3.0 (2.5-3.6; P < 0.001) and 1.5 (95% CI: 1.3-1.8; P < 0.001), respectively. This relationship between FIM score and readmission held across diagnostic category. Medical patients with low functional status had the highest readmission rate (OR: 29%; 95% CI: 25%-32%) and an adjusted OR for readmission of 3.2 (95% CI: 2.4-4.3, P < 0.001) compared to medical patients with high FIM scores. CONCLUSIONS AND RELEVANCE: For patients admitted to an acute inpatient rehabilitation facility, functional status near the time of discharge from an acute care hospital is strongly associated with acute care readmission, particularly for medical patients with greater functional impairments. Reducing functional status decline during acute care hospitalization may be an important strategy to lower readmissions.
Functional decline among elderly patients admitted for different illnesses : a cohort study
2016
Background: Elderly who survive after acute insults are frequently left with intractable complications and multimorbidity. Episodes of hospitalization frequently cause physical limitations among these patients, but illness-specific estimates of functional decline are unclear. Methods: We utilized a prospectively collected cohort of elderly patients (≥ 65) admitted to the general medical wards between January 2014 and August 2014, for analysis. All participants completed questionnaires about clinical features, comorbidity profiles, and pre-morbid functional status, estimated by Barthel Index (BI) on admission. Dedicated nurse practitioners assessed BI on admission and at discharge for enrollees, and the results were analyzed according to their main admission diagnostic categories. Results: We recruited one hundred and fifty-two elderly patients (mean, 80.4 years; 51% male), among whom 55% had hypertension and 39% had diabetes. They were admitted mainly for pulmonary disorders (46%), ...
The European Journal of Public Health, 2005
Objective: To develop a predictive tool that could be used on admission to identify older hospitalized people at risk of functional decline 3 months after discharge. Methods: This was a prospective cohort study that included 625 patients aged 70 years and older (mean age 80.0 ± 5.6 years) hospitalized by the way of the emergency room, for at least 48 h, in two academic hospitals. Three months after discharge, 550 patients remained for analysis. On admission, people were assessed for premorbid functional status with the activities of daily living (ADL) scale and instrumental ADL scale. Demographic and medical data, including cognitive function, falls, polypharmacy, comorbidity, continence, mobility and self-rated health, were collected. ADL functioning was reassessed at discharge and 1 and 3 months later. Functional decline was defined as the loss of at least one point on the ADL scale between the premorbid and 3-month evaluation. Univariate analyses were used to select variables associated with functional decline. A logistic regression model was then constructed to predict functional status 3 months after discharge. Results: Three months after discharge, 165 (31.5%) patients had declined. The predictive tool SHERPA includes five factors: age, impairment in premorbid instrumental ADLs, falls in the year before hospitalization, cognitive impairment (Abbreviated Mini Mental State below 15/21) and poor self-rated health. Sensitivity and specificity were 67.9% and 70.8%, respectively. Conclusions: Older people are at high risk of functional decline following hospitalization. On admission, a simple instrument can easily identify these patients, even though the performance of this instrument is moderate.
The Journals …, 2010
Background. Older medical patients often experience a decline in function associated with hospitalization. Some of this decline is already established at hospital admission, whereas some occurs during hospitalization. Objectives of this study were to separately describe pre-hospital and in-hospital functional changes in older Australian medical patients and to identify risk factors associated with these functional changes. Methods. Secondary analysis of data from a prospective controlled trial conducted in general medical units of an Australian tertiary teaching hospital. Participants were 615 consecutive patients aged 65 years or older admitted under a general medical unit for more than 2 days, discharged alive, and not fully dependent at pre-admission baseline. Activities of daily living measured 2 weeks before admission, at admission, and at discharge were used to calculate rates of prehospital and in-hospital decline and of in-hospital recovery to pre-admission function. Potential predictors including age, sex, diagnosis, illness severity, pre-admission function, pre-admission supports, and documented "geriatric syndromes" (dementia, falls, malnutrition) were investigated for each functional change outcome using multiple logistic regression models. Results. Sixty-four percent of participants had pre-hospital functional decline; only 42% of these had recovered to pre-admission function by hospital discharge. Only 7% had in-hospital decline. The different functional change variables had distinct patterns of predictors. Conclusions. Most decline occurred prior to hospitalization and was associated with common indicators of poor outcomes in hospitalized elders. In-hospital decline was uncommon, suggesting that in-hospital recovery may be a more appropriate intervention target.
Functional decline two weeks before hospitalization in an elderly population
Aging Clinical and Experimental Research, 2010
Introduction: The use of hospital care increases significantly with age. Older people coming to the emergency department have three to seven times higher rates of hospitalization than younger people. Hospitalization can lead to loss of independence and also need for long-term care at discharge.
Revista de la Facultad de Ciencias Médicas de Córdoba
Introduction: Hospitalization represents a major factor that may precipitate the loss of functional status and the cascade into dependence. The main objective of our study was to determine the effect of functional status measured before hospital admission on survival at one year after hospitalization in elderly patients. Methods: Prospective cohort study of adult patients (over 65 years of age) admitted to either the general ward or intensive Care units (ICU) of a tertiary teaching hospital in Buenos Aires, Argentina. Main exposure was the pre-admission functional status determined by means of the modified “VIDA” questionnaire, which evaluates the instrumental activities of daily living. We used a multivariate Cox proportional hazards model to estimate the effect of prior functional status on time to all-cause death while controlling for measured confounding. Secondarily, we analyzed the effect of post-discharge functional decline on long-term outcomes. Results: 297 patients were in...
Functional Trajectories During Hospitalization: A Prognostic Sign for Elderly Patients
The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2009
O LDER individuals are a heterogeneous population in which chronological age may not accurately refl ect the functional reserve and life expectancy (1). Clinicians have used measurements of existing conditions and functional status to attempt capturing this heterogeneity in different settings of care for prognostic and therapeutic purposes (2 , 3). In particular, researchers have focused on age, severity of illness, and comorbidity, investigating determinants of outcomes in elderly patients admitted to intensive care units. Age itself is not the main predictor of poor outcomes, whereas severity of illness, impaired levels of consciousness, incident rate of infection, and comorbidity are the most relevant factors independently associated with mortality (4-6). In addition, also limitation and decline in functional status in an elderly population are predictors of mortality (7). Focusing the attention on acutely ill hospitalized patients, it may be observed that functional status at admission and the functional change after an acute disease are mirrors of a broader condition of inability to react to stressful events (8). On this line, the goal of the study was to evaluate whether the inability to regain functional status during hospitalization predicts mortality. Methods Among 24 beds of an acute geriatric ward (Poliambulanza General Hospital, Brescia, Italy), organized following the Acute Care for the Elderly (ACE) model (6), four beds were arranged as a high-dependency area where acute severely ill elderly patients requiring frequent, but usually not invasive, monitoring of vital signs and intensive interventions are admitted. The four-bed unit provides a level of care between ordinary medical wards and intensive care units (9 , 10), and it is equipped with monitors for cardiac and respiratory function, noninvasive mechanical ventilators, peristaltic and volumetric pumps for intravenous therapy, and enteral nutrition. It is staffed with specially trained nurses and doctors, has a nurse to patient ratio of 1:4, and a physician available 24 hours a day. The study was approved by the institutional research board of our hospital. We retrospectively examined medical charts of 2,415 elderly patients consecutively admitted from March 2003 to March 2007. Patients were excluded (n = 968) if they did not have a change in function during the hospitalization and if they had a premorbid Barthel Index less than or equal to 10 as the aim of the study was to evaluate the association