Functional decline in geriatric rehabilitation ward; is it ascribable to hospital acquired infection? A prospective cohort study

Abstract

Background In some European countries, including France, older patients with functional decline in acute units are transferred to geriatric rehabilitation units. Some patients may not benefit from their stay in a geriatric rehabilitation unit and paradoxically worsened their functional status. Previous prognostic models of functional decline are based on only baseline parameters. However, some events can occur during rehabilitation and modify the association between baseline parameters and rehabilitation performance such as heart failure episode, falls or hospital-acquired infection (HAI). The incidence of functional decline in these units and factors associated with this decline have not been clearly identified. Methods We used a prospective cohort of consecutive patients aged ≥75 years admitted to a geriatric rehabilitation unit in a French university hospital. The main endpoint was functional decline defined by at least an one-point decrease in Activities of Daily Living (ADL) score during the stay. Baseline social and geriatric characteristics were recorded and comorbidities were sought by the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). During follow-up, hospital-acquired infection (HAI) was recorded, as was ADL score at discharge. Multivariate logistic regression and mediation analyses were used to identify factors associated with ADL decrease. Results Among the 252 eligible patients, 160 (median age 84 years [interquartile range (IQR) 80–88] had available ADL scores at baseline (median score 7 [IQR 4–10]) and at discharge (median 9 [6–12]). Median CIRS-G score was 11 [8–13], 23 (14%) had a pulmonary HAI; 28 (17.5%) showed functional decline. On multivariable analysis, functional decline was associated with comorbidities (global CIRS-G score, P = 0.02, CIRS-G for respiratory disease [CIRS-G-R] ≥2, P = 0.02, or psychiatric disease, P = 0.02) and albumin level < 35 g/l (p = 0.03). Significant associations were found between functional decline and CIRS-G-R (OR 3.07 [95%CI 1.27–7.41], p = 0.01), between functional decline and pulmonary HAI (OR 3.12 [1.17–8.32],p = 0.02), and between CIRS-G-R and pulmonary HAI (OR 12.9[4.4–37.7], p = 0.0001). Theses associations and the reduced effect of CIRS-G-R on functional decline after adjusting for pulmonary HAI (OR 2.26 [0.83–6.16], p = 0.11) suggested partial mediation of pulmonary HAI in the relation between CIRS-G-R and functional decline. Conclusion Baseline comorbidities were independently associated with functional decline in patients hospitalized in a geriatric rehabilitation unit. Pulmonary HAI may have mediated this association. We need to better identify patients at risk of functional decline before transfer to a rehabilitation unit and to test the implementation of modern and individual programs of rehabilitation outside the hospital for these patients.

Serum Leptin Levels, Nutritional Status, and the Risk of Healthcare-Associated Infections in Hospitalized Older Adults

“…The median (range) age was 84.8 (75–101) years, and 168 (72.4%) of the 232 participants were female ( Table 1 ). The median (IQR) CIRS-G and ADL scores were 11 [ 9 , 10 , 11 , 12 , 13 , 14 ] and 8 [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ], respectively. According to the MNA, 50 participants (21.6%) showed malnutrition and 125 (53.9%) were at risk of malnutrition.…”

“…HAIs are highly prevalent in hospitalized older patients and may be associated with functional decline, high health care costs, and mortality [ 12 , 13 ]. We have reported previously that in older patients admitted to a rehabilitation care facility, subsequent HAIs were associated with lower baseline values for energy intake and serum albumin, independently of immune variables [ 14 ].…”

Psychometric properties of the Persian version of the Physical Activity Scale for the Elderly (PASE)

“…There are several tools for measuring daily activity in adult populations, which are also used for the elderly. Some of them are Functional Independence Measure (FMI), Barthel index and Katz Activities of Daily Living (ADL) [ 19 , 20 ]. Although these tools, have been good metrics proprieties and are widely used to assess functional decline [ 19 ] some of them, such as the Katz Index used to assess the level of independence in older adults [ 20 ].…”

“…Some of them are Functional Independence Measure (FMI), Barthel index and Katz Activities of Daily Living (ADL) [ 19 , 20 ]. Although these tools, have been good metrics proprieties and are widely used to assess functional decline [ 19 ] some of them, such as the Katz Index used to assess the level of independence in older adults [ 20 ]. Specifically, most activity questionnaires do assess moderate-to-vigorous physical activity and not involved in less strenuous activities such as light housework [ 21 , 22 ].…”

Exploration of Aging-Care Parameters to Predict Mortality of Patients Aged 80-Years and Above with Community-Acquired Pneumonia

“…The incidence accounts for 17.5% among patients 75 years and older. 50 Functional status decline has been proved to be associated with adverse outcomes in many diseases. [51][52][53] Functional status was also reported to be a prognostic factor for patients with community-acquired pneumonia, according to prospective studies.…”