Lona Mody1, Rongjun Sun, Suzanne F Bradley. 1. Division of Geriatric Medicine, Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan 48105, USA. lonamody@umich.edu
Abstract
OBJECTIVES: Evaluate the effect of preadmission functional status on severity of pneumonia, length of hospital stay (LOS), and all-cause 30-day and 1-year mortality of adults aged 60 and older and to understand the effect of pneumonia on short-term functional impairment. DESIGN: Prospective cohort study. SETTING: University hospital. PARTICIPANTS: One hundred twelve patients with radiograph-proven pneumonia (mean age 74.6) were enrolled. MEASUREMENTS: Functional status and comorbidities were assessed using the Functional Autonomy Measurement System (SMAF) and Charlson Comorbidity Index. Clinical information was used to calculate the Pneumonia Prognostic Index (PPI). RESULTS: Eighty-four (75%) patients were functionally independent (FI) before admission, with a SMAF score of 40 or lower. Dementia and aspiration history were higher in the group that was functionally dependent (FD) before admission (P<.001). The FI group had less-severe pneumonia per the PPI and shorter mean LOS+/-standard deviation (5.62+/-0.51 days) than the FD group (11.42+/-2.58, P<.004). The FI group had lower 1-year mortality (19/65, 23%) than the FD group (14/28, 50%), and the difference remained significant after adjusting for Charlson Index and severity of illness (P=.009). All patients lost function after admission, with loss being more pronounced in the FI group (mean change 19.24+/-12.9 vs 4.72+/-6.55, P<.001). CONCLUSION: Older adults who were FI before admission were more likely to present with less-severe pneumonia and have a shorter LOS. In addition, further loss of function was common in these patients. Assessment of function before and during hospitalization should be an integral part of clinical evaluation in all older adults with pneumonia.
OBJECTIVES: Evaluate the effect of preadmission functional status on severity of pneumonia, length of hospital stay (LOS), and all-cause 30-day and 1-year mortality of adults aged 60 and older and to understand the effect of pneumonia on short-term functional impairment. DESIGN: Prospective cohort study. SETTING: University hospital. PARTICIPANTS: One hundred twelve patients with radiograph-proven pneumonia (mean age 74.6) were enrolled. MEASUREMENTS: Functional status and comorbidities were assessed using the Functional Autonomy Measurement System (SMAF) and Charlson Comorbidity Index. Clinical information was used to calculate the Pneumonia Prognostic Index (PPI). RESULTS: Eighty-four (75%) patients were functionally independent (FI) before admission, with a SMAF score of 40 or lower. Dementia and aspiration history were higher in the group that was functionally dependent (FD) before admission (P<.001). The FI group had less-severe pneumonia per the PPI and shorter mean LOS+/-standard deviation (5.62+/-0.51 days) than the FD group (11.42+/-2.58, P<.004). The FI group had lower 1-year mortality (19/65, 23%) than the FD group (14/28, 50%), and the difference remained significant after adjusting for Charlson Index and severity of illness (P=.009). All patients lost function after admission, with loss being more pronounced in the FI group (mean change 19.24+/-12.9 vs 4.72+/-6.55, P<.001). CONCLUSION: Older adults who were FI before admission were more likely to present with less-severe pneumonia and have a shorter LOS. In addition, further loss of function was common in these patients. Assessment of function before and during hospitalization should be an integral part of clinical evaluation in all older adults with pneumonia.
Authors: M J Fine; T E Auble; D M Yealy; B H Hanusa; L A Weissfeld; D E Singer; C M Coley; T J Marrie; W N Kapoor Journal: N Engl J Med Date: 1997-01-23 Impact factor: 91.245
Authors: S K Inouye; D R Wagner; D Acampora; R I Horwitz; L M Cooney; L D Hurst; M E Tinetti Journal: J Gen Intern Med Date: 1993-12 Impact factor: 5.128
Authors: Francisco Sanz; María Morales-Suárez-Varela; Estrella Fernández; Luis Force; María José Pérez-Lozano; Vicente Martín; Mikel Egurrola; Jesús Castilla; Jenaro Astray; Diana Toledo; Ángela Domínguez Journal: J Gen Intern Med Date: 2018-01-04 Impact factor: 5.128