Pre-admission functional decline predicts functional improvement among older patients admitted to acute care hospital

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Abstract

Background: Functional decline from pre-admission to admission may represent an important predictor of functional trajectories during hospitalization among older patients. Therefore, we aimed at describing the impact of pre-admission decline on functional trajectories among older hospitalized patients.

Methods: Our series consisted of 2011 patients aged 65 or more consecutively admitted to 4 acute care wards of Geriatric Medicine participating to a multicenter observational study. Enrolled patients underwent comprehensive geriatric assessment (CGA) by Inter-RAI Minimum Data Set. Main outcomes were functional decline or improvement from hospital admission to discharge based on Activities of Daily Living (ADL) scale. The main exposure variable was ADL decline during the pre-admission period (i.e. three days before the onset of acute illness), and its impact on functional trajectories during stay was investigated by Cox regression models after adjusting for potential confounders.

Results: After adjusting for potential confounders, pre-admission functional decline was significantly associated with functional improvement during stay (HR=6.65; 95%CI=5.01-8.84), but not with functional decline. Severe cognitive impairment (HR=0.28, 95%CI=0.13-0.60), visual impairment (HR=0.60, 95%CI=0.41-0.89), and weight loss (HR=0.67, 95%CI=0.47-0.94) were associated with functional improvement during stay. Hearing impairment (HR=1.94, 95%CI=1.17-3.23) and mild (HR=2.54, 95%CI=1.41-4.58) or severe cognitive impairment (HR=2.72, 95%CI=1.13-6.56) were associated with functional decline during stay.

Conclusions: Patients experiencing recent pre-admission functional decline should be considered as those for which the geriatric approach may lead to the better functional result in the acute care setting. CGA allows to individuate risk factors to be addressed in the acute care setting.

Original languageEnglish
JournalJournals of Gerontology - Series A Biological Sciences and Medical Sciences
DOIs
Publication statusE-pub ahead of print - Oct 26 2017

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Geriatric Assessment
Activities of Daily Living
Geriatrics
Vision Disorders
Hearing Loss
Proportional Hazards Models
Multicenter Studies
Observational Studies
Weight Loss
Hospitalization
Medicine
Cognitive Dysfunction

Cite this

@article{e62527f3a7bf44c190312cfc6fd42af6,
title = "Pre-admission functional decline predicts functional improvement among older patients admitted to acute care hospital",
abstract = "Background: Functional decline from pre-admission to admission may represent an important predictor of functional trajectories during hospitalization among older patients. Therefore, we aimed at describing the impact of pre-admission decline on functional trajectories among older hospitalized patients.Methods: Our series consisted of 2011 patients aged 65 or more consecutively admitted to 4 acute care wards of Geriatric Medicine participating to a multicenter observational study. Enrolled patients underwent comprehensive geriatric assessment (CGA) by Inter-RAI Minimum Data Set. Main outcomes were functional decline or improvement from hospital admission to discharge based on Activities of Daily Living (ADL) scale. The main exposure variable was ADL decline during the pre-admission period (i.e. three days before the onset of acute illness), and its impact on functional trajectories during stay was investigated by Cox regression models after adjusting for potential confounders.Results: After adjusting for potential confounders, pre-admission functional decline was significantly associated with functional improvement during stay (HR=6.65; 95{\%}CI=5.01-8.84), but not with functional decline. Severe cognitive impairment (HR=0.28, 95{\%}CI=0.13-0.60), visual impairment (HR=0.60, 95{\%}CI=0.41-0.89), and weight loss (HR=0.67, 95{\%}CI=0.47-0.94) were associated with functional improvement during stay. Hearing impairment (HR=1.94, 95{\%}CI=1.17-3.23) and mild (HR=2.54, 95{\%}CI=1.41-4.58) or severe cognitive impairment (HR=2.72, 95{\%}CI=1.13-6.56) were associated with functional decline during stay.Conclusions: Patients experiencing recent pre-admission functional decline should be considered as those for which the geriatric approach may lead to the better functional result in the acute care setting. CGA allows to individuate risk factors to be addressed in the acute care setting.",
author = "Cristina Gagliardi and Andrea Corsonello and {Di Rosa}, Mirko and Paolo Fabbietti and Antonio Cherubini and Oriano Mercante and Bruno Mazzei and Demetrio Postacchini and Alberto Deales and Silvia Bustacchini and Fabrizia Lattanzio",
year = "2017",
month = "10",
day = "26",
doi = "10.1093/gerona/glx211",
language = "English",
journal = "Journals of Gerontology - Series A Biological Sciences and Medical Sciences",
issn = "1079-5006",
publisher = "Oxford University Press",

}

TY - JOUR

T1 - Pre-admission functional decline predicts functional improvement among older patients admitted to acute care hospital

AU - Gagliardi, Cristina

AU - Corsonello, Andrea

AU - Di Rosa, Mirko

AU - Fabbietti, Paolo

AU - Cherubini, Antonio

AU - Mercante, Oriano

AU - Mazzei, Bruno

AU - Postacchini, Demetrio

AU - Deales, Alberto

AU - Bustacchini, Silvia

AU - Lattanzio, Fabrizia

PY - 2017/10/26

Y1 - 2017/10/26

N2 - Background: Functional decline from pre-admission to admission may represent an important predictor of functional trajectories during hospitalization among older patients. Therefore, we aimed at describing the impact of pre-admission decline on functional trajectories among older hospitalized patients.Methods: Our series consisted of 2011 patients aged 65 or more consecutively admitted to 4 acute care wards of Geriatric Medicine participating to a multicenter observational study. Enrolled patients underwent comprehensive geriatric assessment (CGA) by Inter-RAI Minimum Data Set. Main outcomes were functional decline or improvement from hospital admission to discharge based on Activities of Daily Living (ADL) scale. The main exposure variable was ADL decline during the pre-admission period (i.e. three days before the onset of acute illness), and its impact on functional trajectories during stay was investigated by Cox regression models after adjusting for potential confounders.Results: After adjusting for potential confounders, pre-admission functional decline was significantly associated with functional improvement during stay (HR=6.65; 95%CI=5.01-8.84), but not with functional decline. Severe cognitive impairment (HR=0.28, 95%CI=0.13-0.60), visual impairment (HR=0.60, 95%CI=0.41-0.89), and weight loss (HR=0.67, 95%CI=0.47-0.94) were associated with functional improvement during stay. Hearing impairment (HR=1.94, 95%CI=1.17-3.23) and mild (HR=2.54, 95%CI=1.41-4.58) or severe cognitive impairment (HR=2.72, 95%CI=1.13-6.56) were associated with functional decline during stay.Conclusions: Patients experiencing recent pre-admission functional decline should be considered as those for which the geriatric approach may lead to the better functional result in the acute care setting. CGA allows to individuate risk factors to be addressed in the acute care setting.

AB - Background: Functional decline from pre-admission to admission may represent an important predictor of functional trajectories during hospitalization among older patients. Therefore, we aimed at describing the impact of pre-admission decline on functional trajectories among older hospitalized patients.Methods: Our series consisted of 2011 patients aged 65 or more consecutively admitted to 4 acute care wards of Geriatric Medicine participating to a multicenter observational study. Enrolled patients underwent comprehensive geriatric assessment (CGA) by Inter-RAI Minimum Data Set. Main outcomes were functional decline or improvement from hospital admission to discharge based on Activities of Daily Living (ADL) scale. The main exposure variable was ADL decline during the pre-admission period (i.e. three days before the onset of acute illness), and its impact on functional trajectories during stay was investigated by Cox regression models after adjusting for potential confounders.Results: After adjusting for potential confounders, pre-admission functional decline was significantly associated with functional improvement during stay (HR=6.65; 95%CI=5.01-8.84), but not with functional decline. Severe cognitive impairment (HR=0.28, 95%CI=0.13-0.60), visual impairment (HR=0.60, 95%CI=0.41-0.89), and weight loss (HR=0.67, 95%CI=0.47-0.94) were associated with functional improvement during stay. Hearing impairment (HR=1.94, 95%CI=1.17-3.23) and mild (HR=2.54, 95%CI=1.41-4.58) or severe cognitive impairment (HR=2.72, 95%CI=1.13-6.56) were associated with functional decline during stay.Conclusions: Patients experiencing recent pre-admission functional decline should be considered as those for which the geriatric approach may lead to the better functional result in the acute care setting. CGA allows to individuate risk factors to be addressed in the acute care setting.

U2 - 10.1093/gerona/glx211

DO - 10.1093/gerona/glx211

M3 - Article

C2 - 29087448

JO - Journals of Gerontology - Series A Biological Sciences and Medical Sciences

JF - Journals of Gerontology - Series A Biological Sciences and Medical Sciences

SN - 1079-5006

ER -