Sandrine Sourdet1, Christine Lafont2, Yves Rolland3, Fati Nourhashemi3, Sandrine Andrieu3, Bruno Vellas3. 1. Gérontopôle, Hôpital La Grave-Casselardit, Toulouse, France. Electronic address: sourdet.s@chu-toulouse.fr. 2. Gérontopôle, Hôpital La Grave-Casselardit, Toulouse, France. 3. Gérontopôle, Hôpital La Grave-Casselardit, Toulouse, France; Inserm Unit 1027, Toulouse, France; Department of Medicine, University of Toulouse III, Toulouse, France.
Abstract
BACKGROUND: In older patients, hospitalization is often associated with new or worsening disability. This hospitalization-associated disability may be explained in part by the cumulative effect of aging, frailty, comorbidities, and illnesses that led to hospitalization but may also result from health care management issues and the hospital environment. Our objective was to determine the frequency, causes, and the preventability of disability induced by the processes of care or "iatrogenic disability." METHODS: A total of 503 patients, aged 75 years and older, hospitalized in the 105 medical and surgical units of Toulouse University Hospital between October 2011 and March 2012, with a minimal length of stay of 2 days, were included. Hospitalization-associated disability was defined as a loss of 0.5 points or more in the Katz Activity of Daily Living Score between the time of hospital admission and discharge. To determine the iatrogenic component of hospitalization-associated disability, an expert panel in geriatric medicine reviewed each medical chart using a standardized record review and identified precipitating iatrogenic adverse events resulting in functional decline. RESULTS: Incidence of iatrogenic disability was 11.9% (95% confidence interval, 9.2%-15.1%). Of the 60 cases of iatrogenic disability, 49 (81.7%, 95% confidence interval, 69.6%-90.5%) were judged to be potentially preventable. The most common health management issues identified in patients with preventable iatrogenic disability were low mobilization [by excessive bed rest (26.5%) and lack of physical therapist intervention (55.1%)], overuse of diapers (49.0%), and transurethral urinary catheterization (30.6%). CONCLUSIONS: The present study suggests that a significant proportion of hospitalization-associated disability may be induced by iatrogenic events, and that most of them are potentially preventable. Health care professionals need to be educated on the specific needs of elderly hospitalized patients and should consider hospitalization-associated disability as an outcome of care.
BACKGROUND: In older patients, hospitalization is often associated with new or worsening disability. This hospitalization-associated disability may be explained in part by the cumulative effect of aging, frailty, comorbidities, and illnesses that led to hospitalization but may also result from health care management issues and the hospital environment. Our objective was to determine the frequency, causes, and the preventability of disability induced by the processes of care or "iatrogenic disability." METHODS: A total of 503 patients, aged 75 years and older, hospitalized in the 105 medical and surgical units of Toulouse University Hospital between October 2011 and March 2012, with a minimal length of stay of 2 days, were included. Hospitalization-associated disability was defined as a loss of 0.5 points or more in the Katz Activity of Daily Living Score between the time of hospital admission and discharge. To determine the iatrogenic component of hospitalization-associated disability, an expert panel in geriatric medicine reviewed each medical chart using a standardized record review and identified precipitating iatrogenic adverse events resulting in functional decline. RESULTS: Incidence of iatrogenic disability was 11.9% (95% confidence interval, 9.2%-15.1%). Of the 60 cases of iatrogenic disability, 49 (81.7%, 95% confidence interval, 69.6%-90.5%) were judged to be potentially preventable. The most common health management issues identified in patients with preventable iatrogenic disability were low mobilization [by excessive bed rest (26.5%) and lack of physical therapist intervention (55.1%)], overuse of diapers (49.0%), and transurethral urinary catheterization (30.6%). CONCLUSIONS: The present study suggests that a significant proportion of hospitalization-associated disability may be induced by iatrogenic events, and that most of them are potentially preventable. Health care professionals need to be educated on the specific needs of elderly hospitalized patients and should consider hospitalization-associated disability as an outcome of care.
Authors: Christine Loyd; Alayne D Markland; Yue Zhang; Mackenzie Fowler; Sara Harper; Nicole C Wright; Christy S Carter; Thomas W Buford; Catherine H Smith; Richard Kennedy; Cynthia J Brown Journal: J Am Med Dir Assoc Date: 2019-11-14 Impact factor: 4.669
Authors: Anita N Chary; Noelle Castilla-Ojo; Christopher Joshi; Ilianna Santangelo; Christopher R Carpenter; Kei Ouchi; Aanand D Naik; Shan W Liu; Maura Kennedy Journal: J Am Geriatr Soc Date: 2021-12-06 Impact factor: 7.538
Authors: John R Beard; Alana Officer; Islene Araujo de Carvalho; Ritu Sadana; Anne Margriet Pot; Jean-Pierre Michel; Peter Lloyd-Sherlock; JoAnne E Epping-Jordan; G M E E Geeske Peeters; Wahyu Retno Mahanani; Jotheeswaran Amuthavalli Thiyagarajan; Somnath Chatterji Journal: Lancet Date: 2015-10-29 Impact factor: 79.321