Many hospitalized older people are discharged with ADL function that is worse than their baseline function. The oldest patients are at particularly high risk of poor functional outcomes because they are less likely to recover ADL function lost before admission and more likely to develop new functional deficits during hospitalization

Specific changes in the provision of acute hospital care can improve the ability of a heterogeneous group of acutely ill older patients to perform basic activities of daily living at the time of discharge from the hospital and can reduce the frequency of discharge to institutions for long-term care.

OBJECTIVES-To describe functional outcomes in the year following discharge for elders discharged from the hospital after an acute medical illness with a new or additional disability in Dr. Boyd conceptualized this paper, obtained funding, developed the design of the analysis with Drs. Covinsky and wrote this manuscript. Dr. Landefeld was responsible for collaborating in the following activities for this paper: study design and implementation, obtainment of funding, analysis and interpretation of data and critical revision of the manuscript for important intellectual content. Dr. Counsell was responsible for collaborating in the following activities for this paper: study design and implementation, obtainment of funding, analysis and interpretation of data and critical revision of the manuscript for important intellectual content. Dr. Palmer was a co-investigator responsible for collaborating in the following activities for this paper: design and implementation, interpretation of data, and critical revision of the manuscript for important intellectual content. Dr. Fortinsky was a co-investigator responsible for collaborating in the following activities for this paper: the analysis and interpretation of data and critical revision of the manuscript for important intellectual content. Dr. Kresevic was a co-investigator responsible for collaborating in the following activities for this paper: design and implementation, interpretation of data, and critical revision of the manuscript for important intellectual content. Dr. Covinsky was responsible for supervision of the entire project and manuscript, and collaborated on the design and implementation, analysis and interpretation of data, and undertook critical revision of this manuscript for important intellectual content. Sponsors' Role:The funding sources had no role in the design and conduct of the study, collection, management, analysis or interpretation of the data, the preparation, review or approval of the manuscript. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript their basic self-care activities of daily living(ADL)(compared to their preadmission baseline two weeks before admission), compared to elders discharged with baseline ADL function, and identify predictors of failure to recover to baseline function one year after discharge. DESIGN-Observational Study SETTING-Tertiary care hospital, Community teaching hospitalPARTICIPANTS-Older(≥70 years) patients non-electively admitted to general medical services (1993)(1994)(1995)(1996)(1997)(1998).MEASUREMENTS-Number of ADL disabilities 1,3,6,&12 months after discharge compared to pre-admission baseline. Outcomes were death, sustained decline in ADL function, and recovery to baseline ADL function at each timepoint.RESULTS-By 12 months after discharge, among those discharged with new or additional ADL disability, 41.3% died, 28.6% were alive but had not recovered to baseline function, and 30.1% were at their baseline function. Among those discharged with baseline fun...