Performance-based functional impairment and readmission and death: a prospective study

Abstract

ObjectivesReadmission and death are frequent after a hospitalisation and difficult to predict. While many predictors have been identified, few studies have focused on functional status. We assessed whether performance-based functional impairment at discharge is associated with readmission and death after an acute medical hospitalisation.Design, setting and participantsWe prospectively included patients aged ≥50 years admitted to the Department of General Internal Medicine of a large community hospital. Functional status was assessed shortly before discharge using the Timed Up and Go test performed twice in a standard way by trained physiotherapists and was defined as a test duration ≥15 s. Sensitivity analyses using a cut-off at >10 and >20 s were performed.Primary and secondary outcome measuresThe primary and secondary outcome measures were unplanned readmission and death, respectively, within 6 months after discharge.ResultsWithin 6 months after discharge, 107/338 (31.7%) patients had an unplanned readmission and 31/338 (9.2%) died. Functional impairment was associated with higher risk of death (OR 2.44, 95% CI 1.15 to 5.18), but not with unplanned readmission (OR 1.34, 95% CI 0.84 to 2.15). No significant association was found between functional impairment and the total number of unplanned readmissions (adjusted OR 1.59, 95% CI 0.95 to 2.67).ConclusionsFunctional impairment at discharge of an acute medical hospitalisation was associated with higher risk of death, but not of unplanned readmission within 6 months after discharge. Simple performance-based assessment may represent a better prognostic measure for mortality than for readmission.

Contribution of oxidative stress in the mechanisms of postoperative complications and multiple organ dysfunction syndrome

“…These complications manifest as an expensive cost for the healthcare systems and for the patients [ 3 ]. It was reported that within 6 months following discharge, approximately 32% of surgical patients had an unplanned readmission and 10% died [ 4 ]. One of the greatest challenges of any physician is to successfully face these complications by preventing, detecting, and managing these issues, for the reason of the high mortality that can be exposed to these patients after a surgical procedure [ 5 ].…”

Racial disparities among older adults with acute myocardial infarction: The SILVER‐AMI study

“…Mobility was measured with the Timed Get Up and Go test, which required the participant to rise from a seated position, walk 3 meters, and then return to the chair and sit down 18 . We applied cut points to classify participants into the following groups: preserved mobility (≤15 s to complete), mild impairment (>15 to ≤25 s to complete), moderate impairment (>25 s to complete) and severe impairment (unable to complete) 19–22 …”

“…18 We applied cut points to classify participants into the following groups: preserved mobility (≤15 s to complete), mild impairment (>15 to ≤25 s to complete), moderate impairment (>25 s to complete) and severe impairment (unable to complete). [19][20][21][22] Participants were asked select questions about vision from the National Eye Institute Visual Function Questionnaire. 23 Responses of "poor," "very poor," or "completely blind" indicated visual impairment.…”

Association of nonpharmacologic chronic pain management with function in a low‐income population: Evidence from a survey of a sample of Latinos from five states

“…This study examines two functional measures: daily impairment in mobility and daily impairment in activities of daily living (ADL). Poor performance on these functional measures has been associated with shorter survival in diverse populations 15‐18 . Given expert recommendations to prioritize nonpharmacologic management of chronic pain, 1,3 we examined outcomes associated with specific categories of care including supervised, professional physical interventions (eg, physical therapy); professional mind‐body intervention (eg, mindfulness/meditation); and personal activities (eg, changing diet).…”

“…Poor performance on these functional measures has been associated with shorter survival in diverse populations. [15][16][17][18] Given expert recommendations to prioritize nonpharmacologic management of chronic pain, 1,3 we examined outcomes associated with specific categories of care including supervised, professional physical interventions (eg, physical therapy); professional mind-body intervention (eg, mindfulness/meditation); and personal activities (eg, changing diet). These categories were defined from pain management approaches described by focus groups with community-based Latinos with chronic pain.…”