The Severity of Acute Illness and Functional Trajectories in Hospitalized Older Medical Patients

Fimognari, Filippo Luca; Pierantozzi, Andrea; Alfieri, Walter De; Salani, Bernardo; Zuccaro, Stefano Maria; Arone, Andrea; Palleschi, Giacomo; Palleschi, Lorenzo

doi:10.1093/gerona/glw096

Cited by 53 publications

(42 citation statements)

References 23 publications

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“…These findings support the theory that acute illness and age-related changes can lead to loss of muscle mass and physical performance, resulting in functional decline and reduced physical activity. 19 In this light, our results suggest that particularly frail older adults, who are more likely to be functionally vulnerable to an acute illness, 52 become less active after an acute illness. 20 Offering targeted interventions to these vulnerable individuals to improve their physical performance and physical activity while they are in hospital may improve postdischarge activity levels.…”

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confidence: 68%

Factors Associated with Step Numbers in Acutely Hospitalized Older Adults: The Hospital-Activities of Daily Living Study

Kolk

Aarden

Vroomen

et al. 2021

Journal of the American Medical Directors Association

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Objectives: To determine the number of steps taken by older patients in hospital and 1 week after discharge; to identify factors associated with step numbers after discharge; and to examine the association between functional decline and step numbers after discharge. Design: Prospective observational cohort study conducted in 2015e2017. Setting and Participants: Older adults (!70 years of age) acutely hospitalized for at least 48 hours at internal, cardiology, or geriatric wards in 6 Dutch hospitals. Methods: Steps were counted using the Fitbit Flex accelerometer during hospitalization and 1 week after discharge. Demographic, somatic, physical, and psychosocial factors were assessed during hospitalization. Functional decline was determined 1 month after discharge using the Katz activities of daily living index. Results: The analytic sample included 188 participants [mean age (standard deviation) 79.1 (6.7)]. One month postdischarge, 33 out of 174 participants (19%) experienced functional decline. The median number of steps was 656 [interquartile range (IQR), 250e1146] at the last day of hospitalization. This increased to 1750 (IQR 675e4114) steps 1 day postdischarge, and to 1997 (IQR 938e4098) steps 7 days postdischarge. Age [b ¼ À57.93; 95% confidence interval (CI) À111.15 to À4.71], physical performance (b ¼ 224.95; 95% CI 117.79e332.11), and steps in hospital (b ¼ 0.76; 95% CI 0.46e1.06) were associated with steps postdischarge. There was a significant association between step numbers after discharge and functional decline 1 month after discharge (b ¼ À1400; 95% CI e2380 to À420; P ¼ .005). Conclusions and Implications: Among acutely hospitalized older adults, step numbers double 1 day postdischarge, indicating that their capacity is underutilized during hospitalization. Physical performance and physical activity during hospitalization are key to increasing the number of steps

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mentioning

confidence: 68%

Factors Associated with Step Numbers in Acutely Hospitalized Older Adults: The Hospital-Activities of Daily Living Study

Kolk

Aarden

Vroomen

et al. 2021

Journal of the American Medical Directors Association

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“…This may indicate that an important predictor may be missing. For example, medical comorbidities and illness severity have also demonstrated an association with functional decline [23]. These variables were not considered in the model because they require diagnostic interviewing and testing and may be too complex for clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Predicting hospitalisation-associated functional decline in older patients admitted to a cardiac care unit with cardiovascular disease: a prospective cohort study

et al. 2020

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Background: Up to one in three of older patients who are hospitalised develop functional decline, which is associated with sustained disability, institutionalisation and death. This study developed and validated a clinical prediction model that identifies patients who are at risk for functional decline during hospitalisation. The predictive value of the model was compared against three models that were developed for patients admitted to a general medical ward. Methods: A prospective cohort study was performed on two cardiac care units between September 2016 and June 2017. Patients aged 75 years or older were recruited on admission if they were admitted for non-surgical treatment of an acute cardiovascular disease. Hospitalisation-associated functional decline was defined as any decrease on the Katz Index of Activities of Daily Living between hospital admission and discharge. Predictors were selected based on a review of the literature and a prediction score chart was developed based on a multivariate logistic regression model. Results: A total of 189 patients were recruited and 33% developed functional decline during hospitalisation. A score chart was developed with five predictors that were measured on hospital admission: mobility impairment = 9 points, cognitive impairment = 7 points, loss of appetite = 6 points, depressive symptoms = 5 points, use of physical restraints or having an indwelling urinary catheter = 5 points. The score chart of the developed model demonstrated good calibration and discriminated adequately (C-index = 0.75, 95% CI (0.68-0.83) and better between patients with and without functional decline (chi 2 = 12.8, p = 0.005) than the three previously developed models (range of C-index = 0.65-0.68).

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“…In summarizing the change in functional mobility in a sample of hospitalized patients as the average change from admission to discharge, we risk oversimplification and misunderstanding. For instance, this improvement in function might not represent complete resolution to a pre‐illness level, and further, a small but significant number of patients are known to deteriorate in function from admission to discharge . This indicates that there might be distinctive subsets of patients with different functional trajectories.…”

Section: Introductionmentioning

confidence: 99%

Functional mobility trajectories of hospitalized older adults admitted to acute geriatric wards: A retrospective observational study in an English university hospital

Lyons

Romero-Ortuño

Hartley

2019

Geriatrics Gerontology Int

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Aim The mobility trajectories of hospitalized older people are heterogeneous, and there is a need to understand patient groups with similar trajectories. Our aims were to identify mobility trajectories of older patients admitted to geriatric wards in an English university hospital, and describe patient characteristics and outcomes associated with different mobility groups. Methods A retrospective observational study of first admissions to geriatric wards for 3 months starting 1 May 2016 was carried out. Anonymized routinely collected clinical data was extracted from the electronic patient records: age, sex, Clinical Frailty Scale score, presence of delirium (yes/no), diagnosis of dementia (yes/no), Charlson Comorbidity Index, falls in the past year and the highest recorded Modified Early Warning Score in the Emergency Department. Physiotherapists routinely collected the Elderly Mobility Scale on admission and discharge; this information was entered in a K‐means cluster analysis to identify mobility trajectory groups. We compared clinical characteristics and outcomes between these groups and used logistic regression models to determine independent predictors of group membership. Results The overall functional trajectory was improvement, from a median Elderly Mobility Scale of 11 on admission to 14 on discharge. Cluster analysis identified five mobility trajectory groups: low‐low (n = 117), intermediate‐intermediate (n = 95), intermediate‐high (n = 205), low‐high (n = 89) and high‐high (n = 209). Higher frailty and the presence of cognitive impairment were associated with the low‐low and intermediate‐intermediate group membership, and negatively associated with the high‐high group membership. Conclusions The majority of hospitalized patients experienced functional improvement. Frailty and cognitive impairment might be associated with poorer mobility trajectories and hence require early identification. Geriatr Gerontol Int 2019; 19: 305–310.

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The Severity of Acute Illness and Functional Trajectories in Hospitalized Older Medical Patients

Abstract: The severity of illnesses was strongly associated with adverse functional outcomes around hospitalization, but frailty, intended as functional vulnerability to the acute disease before hospitalization, was a stronger predictor of HAD than illness severity and age.

Cited by 53 publications

References 23 publications

Factors Associated with Step Numbers in Acutely Hospitalized Older Adults: The Hospital-Activities of Daily Living Study

Factors Associated with Step Numbers in Acutely Hospitalized Older Adults: The Hospital-Activities of Daily Living Study

Predicting hospitalisation-associated functional decline in older patients admitted to a cardiac care unit with cardiovascular disease: a prospective cohort study

Functional mobility trajectories of hospitalized older adults admitted to acute geriatric wards: A retrospective observational study in an English university hospital

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