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01.05.2007 | Populations at Risk

Characteristics of Nondisabled Older Patients Developing New Disability Associated with Medical Illnesses and Hospitalization

verfasst von: Stefano Volpato, MD, MPH, Graziano Onder, MD, PhD, Margherita Cavalieri, MD, Gianluca Guerra, MD, Fotini Sioulis, MD, Cinzia Maraldi, MD, Giovanni Zuliani, MD, PhD, Renato Fellin, MD, PhD, Italian Group of Pharmacoepidemiology in the Elderly Study (GIFA)

Erschienen in: Journal of General Internal Medicine | Ausgabe 5/2007

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Abstract

OBJECTIVE

To identify demographic, clinical, and biological characteristics of older nondisabled patients who develop new disability in basic activities of daily living (BADL) during medical illnesses requiring hospitalization.

DESIGN

Longitudinal observational study.

SETTING

Geriatric and Internal Medicine acute care units.

PARTICIPANTS

Data are from 1,686 patients aged 65 and older who independent in BADL 2 weeks before hospital admission, enrolled in the 1998 survey of the Italian Group of Pharmacoepidemiology in the Elderly Study.

MEASUREMENTS

Study outcome was new BADL disability at time of hospital discharge. Sociodemographic, functional status, and clinical characteristics were collected at hospital admission; acute and chronic conditions were classified according to the International Classification of Disease, ninth revision; fasting blood samples were obtained and processed with standard methods.

RESULTS

At the time of hospital discharge 113 patients (6.7%) presented new BADL disability. Functional decline was strongly related to patients’ age and preadmission instrumental activities of daily living status. In a multivariate analysis, older age, nursing home residency, low body mass index, elevated erythrocyte sedimentation rate, acute stroke, high level of comorbidity expressed as Cumulative Illness Rating Scale score, polypharmacotherapy, cognitive decline, and history of fall in the previous year were independent and significant predictors of BADL disability.

CONCLUSION

Several factors might contribute to loss of physical independence in hospitalized older persons. Preexisting conditions associated with the frailty syndrome, including physical and cognitive function, comorbidity, body composition, and inflammatory markers, characterize patients at high risk of functional decline.

Inouye SK, Wagner DR, Acampora D, et al. A predictive index for functional decline in hospitalized elderly medical patients. J Gen Intern Med. 1993;8:645–52.PubMedCrossRef

Covinsky KE, Palmer RM, Fortinsky RH, et al. Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc. 2003;51:451–8.PubMedCrossRef

Gillick MR, Serrell NA, Gillick LS. Adverse consequences of hospitalization in the elderly. Soc Sci Med. 1982;16:1033–8.PubMedCrossRef

Fortinsky RH, Covinsky KE, Palmer RM, Landefeld CS. Effects of functional status changes before and during hospitalization on nursing home admission of older adults. J Gerontol Ser A Biol Sci Med Sci. 1999;54:M521–6.

Brown CJ, Friedkin RJ, Inouye SK. Prevalence and outcomes of low mobility in hospitalized older patients. J Am Geriatr Soc. 2004;52:1263–70.PubMedCrossRef

Sager MA, Franke T, Inouye SK, et al. Functional outcomes of acute medical illness and hospitalization in older persons. Arch Intern Med. 1996;156:645–52.PubMedCrossRef

Boyd CM, Xue QL, Guralnik JM, Fried LP. Hospitalization and development of dependence in activities of daily living in a cohort of disabled older women: the Women’s Health and Aging Study I. J Gerontol Ser A Biol Sci Med Sci. 2005;60:888–93.

Sager MA, Rudberg MA, Jalaluddin M, et al. Hospital admission risk profile (HARP): identifying older patients at risk for functional decline following acute medical illness and hospitalization. J Am Geriatr Soc. 1996;44:251–7.PubMed

Pedone C, Ercolani S, Catani M, et al. GIFA Study Group. Elderly patients with cognitive impairment have a high risk for functional decline during hospitalization: the GIFA Study. J Gerontol Ser A Biol Sci Med Sci. 2005;60:1576–80.

10.

McCusker J, Kakuma R, Abrahamowicz M. Predictors of functional decline in hospitalized elderly patients: a systematic review. J Gerontol Ser A Biol Sci Med Sci. 2002;57:M569–77.

11.

Carosella L, Pahor M, Pedone C, et al. Pharmacosurveillance in hospitalized patients in Italy. Study design of the ‘Gruppo Italiano di Farmacovigilanza nell’Anziano’ (GIFA). Pharmacol Res. 1999;40:287–95.PubMedCrossRef

12.

Rocca WA, Bonaiuto S, Lippi A, et al. Validation of the Hodkinson abbreviated mental test as a screening instrument for dementia in an Italian population. Neuroepidemiology. 1992;11:288–95.PubMedCrossRef

13.

Shah A, Phongsathorn V, Bielawska C, Katona C. Screening for depression among geriatric inpatients with short version of the Geriatric Depression Scale. Int J Geriatr Psychiatry. 1996;11:915–8.CrossRef

14.

Physical status: the use and interpretation of anthropometry: report of a WHO expert committee. WHO Tech Rep Ser. 1995;854:1–452.

15.

International Classification of Disease, 9th revision, Clinical Modification, 2nd edn. Washington: Public Health Service-Health Care Financing Administration; 1980.

16.

Linn BS, Linn MW, Gurel L. Cumulative illness rating scale. J Am Geriatr Soc. 1968 1968;16(5):622–6.PubMed

17.

Thomas VS, Rockwood K, McDowell I. Multidimensionality in instrumental and basic activities of daily living. J Clin Epidemiol. 1998;51:315–21.PubMedCrossRef

18.

Harrell FE Jr. Regression Modeling Strategies with Applications to Linear Models, Logistic Regression, and Survival Analysis. In: Chatterjee S, Hadi AS, Price B, eds. Regression Analysis by Example, 3rd edn. New York, NY: Springer-Verlag New York; 2001.

19.

Fried LP, Tangen CM, Walston J, et al. Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a phenotype. J Gerontol Ser A Biol Sci Med Sci. 2001;56:M146–56.

20.

Ferrucci L, Bandinelli S, Cavazzini C, et al. Neurological examination findings to predict limitations in mobility and falls in older persons without a history of neurological disease. Am J Med. 2004;116:807–15.PubMedCrossRef

21.

Lindenberger EC, Landefeld CS, Sands LP, et al. Unsteadiness reported by older hospitalized patients predicts functional decline. J Am Geriatr Soc. 2003;51:621–6.PubMedCrossRef

22.

Seidell JC, Visscher TL. Body weight and weight change and their health implications for the elderly. Eur J Clin Nutr. 2000;54(suppl 3):S33–9.PubMed

23.

Landi F, Onder G, Gambassi G, et al. Body mass index and mortality among hospitalized patients. Arch Intern Med. 2000;160:2641–4.PubMedCrossRef

24.

Volpato S, Romagnoni F, Soattin L, et al. Body mass index, body cell mass, and 4-year all-cause mortality risk in older nursing home resident. J Am Geriatr Soc. 2004;52:886–91.PubMedCrossRef

25.

Roubenoff R. Sarcopenia: effects on body composition and function. J Gerontol Ser A Biol Sci Med Sci. 2003;58:1012–7.

26.

Volpato S, Leveille SG, Corti MC, et al. The value of serum albumin and high-density lipoprotein cholesterol in defining mortality risk in older persons with low serum cholesterol. J Am Geriatr Soc. 2001;49:1142–7.PubMedCrossRef

27.

Shlipak MG, Stehman-Breen C, Fried LF, et al. The presence of frailty in elderly persons with chronic renal insufficiency. Am J Kidney Dis. 2004;43:861–7.PubMedCrossRef

28.

Maraldi S, Volpato S, Cesari M, et al. Anemia and recovery from disability in activities of daily living in hospitalized older persons. J Am Geriatr Soc. 2006;54:632–6.PubMedCrossRef

29.

Volpato S, Guralnik JM, Ferrucci L, et al. Cardiovascular disease, interleukin-6 and the risk of mortality in older women: the Women’s Health and Aging Study. Circulation. 2001;103:947–53.PubMed

30.

Ferrucci L, Penninx BW, Volpato S, et al. Change in muscle strength explains accelerated decline of physical function in older women with high interleukin-6 serum levels. J Am Geriatr Soc. 2002;50:1947–54.PubMedCrossRef

31.

Cesari M, Penninx BW, Pahor M, et al. Inflammatory markers and physical performance in older persons: the InCHIANTI study. J Gerontol Ser A Biol Sci Med Sci. 2004;59:242–8.

32.

Ferrucci L, Penninx BW, Leveille SG, et al. Characteristics of nondisabled older persons who perform poorly in objective tests of lower extremity function. J Am Geriatr Soc. 2000;48:1102–10.PubMed

Titel: Characteristics of Nondisabled Older Patients Developing New Disability Associated with Medical Illnesses and Hospitalization
verfasst von: Stefano Volpato, MD, MPH
Graziano Onder, MD, PhD
Margherita Cavalieri, MD
Gianluca Guerra, MD
Fotini Sioulis, MD
Cinzia Maraldi, MD
Giovanni Zuliani, MD, PhD
Renato Fellin, MD, PhD
Italian Group of Pharmacoepidemiology in the Elderly Study (GIFA)
Publikationsdatum: 01.05.2007
Verlag: Springer-Verlag
Erschienen in: Journal of General Internal Medicine / Ausgabe 5/2007
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-007-0152-1

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Abstract

OBJECTIVE

DESIGN

SETTING

PARTICIPANTS

MEASUREMENTS

RESULTS

CONCLUSION

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