BACKGROUND: Archetypal symptoms and signs are commonly absent in frail older people who are acutely unwell. This challenges both recognition of illness and monitoring of disease progression in people at high risk of prolonged hospital stays, institutionalization and death. OBJECTIVE: To determine whether bedside assessment of balance and mobility could track acute changes in the health status of older people admitted to hospital. DESIGN: Prospective cohort study. PARTICIPANTS: Four hundred nine patients, with a mean age of 81.8 years, admitted to general medical and rehabilitation wards at a tertiary care teaching hospital in Halifax, Nova Scotia. No patient refused assessment, and the only exclusion criterion was age. INTERVENTIONS: The Hierarchical Assessment of Balance and Mobility (HABAM) was completed daily during the first 2 weeks of admission. For each patient, frailty status was measured on admission by a Frailty Index based on a Comprehensive Geriatric Assessment (FI-CGA). MAIN MEASURES: Death and discharge destination. KEY RESULTS: Poor performance in balance, transfers and mobility was associated with adverse outcomes. Forty-eight percent of patients with the lowest scores in all three domains died, compared with none with the highest scores. The relative risk of death for people who deteriorated during the first 48 h of admission was 17.1 (95% confidence interval: 4.9-60.3). Changes in HABAM scores were related to the discharge destination: patients discharged home showed the greatest rate of improvement, whereas those discharged to institutions stabilised at a lower level of performance. Fitter patients tended to have better performance on admission and faster recovery. CONCLUSIONS: Daily bedside observation of mobility and balance allows assessment of acute changes in the health of older people. Frailty slows recovery of mobility and balance, and reduces recovery potential. By identifying patients most vulnerable to adverse outcomes, the HABAM and FI-CGA may facilitate risk stratification in older people admitted to hospital.
BACKGROUND: Archetypal symptoms and signs are commonly absent in frail older people who are acutely unwell. This challenges both recognition of illness and monitoring of disease progression in people at high risk of prolonged hospital stays, institutionalization and death. OBJECTIVE: To determine whether bedside assessment of balance and mobility could track acute changes in the health status of older people admitted to hospital. DESIGN: Prospective cohort study. PARTICIPANTS: Four hundred nine patients, with a mean age of 81.8 years, admitted to general medical and rehabilitation wards at a tertiary care teaching hospital in Halifax, Nova Scotia. No patient refused assessment, and the only exclusion criterion was age. INTERVENTIONS: The Hierarchical Assessment of Balance and Mobility (HABAM) was completed daily during the first 2 weeks of admission. For each patient, frailty status was measured on admission by a Frailty Index based on a Comprehensive Geriatric Assessment (FI-CGA). MAIN MEASURES: Death and discharge destination. KEY RESULTS: Poor performance in balance, transfers and mobility was associated with adverse outcomes. Forty-eight percent of patients with the lowest scores in all three domains died, compared with none with the highest scores. The relative risk of death for people who deteriorated during the first 48 h of admission was 17.1 (95% confidence interval: 4.9-60.3). Changes in HABAM scores were related to the discharge destination: patients discharged home showed the greatest rate of improvement, whereas those discharged to institutions stabilised at a lower level of performance. Fitter patients tended to have better performance on admission and faster recovery. CONCLUSIONS: Daily bedside observation of mobility and balance allows assessment of acute changes in the health of older people. Frailty slows recovery of mobility and balance, and reduces recovery potential. By identifying patients most vulnerable to adverse outcomes, the HABAM and FI-CGA may facilitate risk stratification in older people admitted to hospital.
Authors: Alexander M Kulminski; Svetlana V Ukraintseva; Irina V Kulminskaya; Konstantin G Arbeev; Kenneth Land; Anatoli I Yashin Journal: J Am Geriatr Soc Date: 2008-03-21 Impact factor: 5.562
Authors: Samuel D Searle; Arnold Mitnitski; Evelyne A Gahbauer; Thomas M Gill; Kenneth Rockwood Journal: BMC Geriatr Date: 2008-09-30 Impact factor: 3.921
Authors: Denise McGrath; Barry R Greene; Katie Sheehan; Lorcan Walsh; Rose A Kenny; Brian Caulfield Journal: Eur J Appl Physiol Date: 2014-10-26 Impact factor: 3.078
Authors: Tobias Braun; Ralf-Joachim Schulz; Julia Reinke; Nico L van Meeteren; Natalie A de Morton; Megan Davidson; Christian Thiel; Christian Grüneberg Journal: BMC Geriatr Date: 2015-05-03 Impact factor: 3.921
Authors: Emily Gard Marshall; Michelle Anne Boudreau; Jan L Jensen; Nancy Edgecombe; Barry Clarke; Frederick Burge; Greg Archibald; Anthony Taylor; Melissa K Andrew Journal: JMIR Res Protoc Date: 2013-11-29