OBJECTIVES: To investigate the combined contribution of processes of hospitalization and preadmission individual risk factors in explaining functional decline at discharge and at 1-month follow-up in older adults with nondisabling conditions. DESIGN: Prospective cohort study. SETTING: Internal medicine wards in two Israeli medical centers. PARTICIPANTS: Six hundred eighty-four individuals aged 70 and older admitted for a nondisabling problem. MEASUREMENTS: Functional decline was measured according to change in modified Barthel Index from premorbid to discharge and from premorbid to 1 month after discharge. In-hospital mobility, continence care, sleep medication consumption, satisfaction with hospital environment, and nutrition intake were assessed using previously tested self-report instruments. RESULTS: Two hundred eighty-two participants (41.2%) reported functional decline at discharge and 317 (46.3%) at 1 month after discharge. Path analysis indicated that in-hospital mobility (standardized maximum likelihood estimate (SMLE) = -0.48, P < .001), continence care (SMLE = -0.12, P < .001), and length of stay (LOS) (SMLE = 0.06, P < .001) were directly related to functional decline at discharge and, together with personal risk factors, explained 64% of variance. In-hospital mobility, continence care, and LOS were indirectly related to functional decline at 1 month after discharge through functional decline at discharge (SMLE = 0.45, P < .001). Nutrition consumption (SMLE = -0.07, P < .001) was significantly related to functional decline at 1 month after discharge, explaining, together with other risk factors, 32% of variance. CONCLUSION: In-hospital low mobility, suboptimal continence care, and poor nutrition account for immediate and 1-month posthospitalization functional decline. These are potentially modifiable hospitalization risk factors for which practice and policy should be targeted in efforts to curb the posthospitalization functional decline trajectory.
OBJECTIVES: To investigate the combined contribution of processes of hospitalization and preadmission individual risk factors in explaining functional decline at discharge and at 1-month follow-up in older adults with nondisabling conditions. DESIGN: Prospective cohort study. SETTING: Internal medicine wards in two Israeli medical centers. PARTICIPANTS: Six hundred eighty-four individuals aged 70 and older admitted for a nondisabling problem. MEASUREMENTS: Functional decline was measured according to change in modified Barthel Index from premorbid to discharge and from premorbid to 1 month after discharge. In-hospital mobility, continence care, sleep medication consumption, satisfaction with hospital environment, and nutrition intake were assessed using previously tested self-report instruments. RESULTS: Two hundred eighty-two participants (41.2%) reported functional decline at discharge and 317 (46.3%) at 1 month after discharge. Path analysis indicated that in-hospital mobility (standardized maximum likelihood estimate (SMLE) = -0.48, P < .001), continence care (SMLE = -0.12, P < .001), and length of stay (LOS) (SMLE = 0.06, P < .001) were directly related to functional decline at discharge and, together with personal risk factors, explained 64% of variance. In-hospital mobility, continence care, and LOS were indirectly related to functional decline at 1 month after discharge through functional decline at discharge (SMLE = 0.45, P < .001). Nutrition consumption (SMLE = -0.07, P < .001) was significantly related to functional decline at 1 month after discharge, explaining, together with other risk factors, 32% of variance. CONCLUSION: In-hospital low mobility, suboptimal continence care, and poor nutrition account for immediate and 1-month posthospitalization functional decline. These are potentially modifiable hospitalization risk factors for which practice and policy should be targeted in efforts to curb the posthospitalization functional decline trajectory.
Authors: Sheila M Manemann; Alanna M Chamberlain; Cynthia M Boyd; Donna M Miller; Kimberly L Poe; Andrea Cheville; Susan A Weston; Ellen E Koepsell; Ruoxiang Jiang; Véronique L Roger Journal: Circ Cardiovasc Qual Outcomes Date: 2018-08
Authors: Vincenzo Valiani; Shiyao Gao; Zhiguo Chen; Sunil Swami; Christopher A Harle; Gigi Lipori; Sandrine Sourdet; Samuel Wu; Susan G Nayfield; Carlo Sabbá; Marco Pahor; Todd M Manini Journal: J Am Med Dir Assoc Date: 2016-03-09 Impact factor: 4.669