Roya Fathi1,2, Peter Bacchetti3, Mary N Haan3, Thomas K Houston4,5, Kanan Patel1,6, Christine S Ritchie1,6. 1. Division of Geriatrics, University of California at San Francisco, San Francisco, California. 2. Division of Geriatrics, San Francisco Veterans Affairs Medical Center, San Francisco, California. 3. Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California. 4. Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts. 5. Center for Healthcare Organization and Implementation Research, Bedford Veterans Affairs Medical Center, Bedford, Massachusetts. 6. Center for Research on Aging, Jewish Home of San Francisco, San Francisco, California.
Abstract
OBJECTIVES: To describe the association between restricted life-space and characteristics of community-dwelling adults hospitalized for congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD), to estimate the effect of hospitalization on postdischarge mobility, and to determine whether baseline restricted life-space predicts hospital readmission. DESIGN: Observational. SETTING: Urban academic hospital that serves as a safety net for urban and rural populations with low resources and serves central and northern Alabama. PARTICIPANTS: Individuals with CHF or COPD hospitalized from home (N = 478). MEASUREMENTS: The Life-Space Assessment (LSA) measures mobility by asking about movement in situations ranging from within one's dwelling to beyond one's town. LSA scores below 60 correspond to "restricted life-space." Baseline LSA scores before admission were measured during an index hospitalization; follow-up LSA scores were determined over the telephone at 90 days. Participant characteristics were examined according to baseline restricted life-space using the chi-square test and Student's t-test. Each characteristic's association with restricted life-space was estimated uisng logistic regression. RESULTS: Of the participants, 372 (77.8%) were classified as having baseline restricted life-space. Baseline restricted life-space was associated with older age (odds ratio (OR) = 1.29 per decade, 95% confidence interval (CI) = 1.17-1.42, P = .001), female sex (OR = 2.69, 95% CI = 1.69-4.29, P < .001), African-American race (OR = 1.55, 95% CI = 1.00-2.41, P = .05), and having inadequate financial resources (OR = 2.03, 95% CI = 1.22-3.38, P = .006). In the baseline unrestricted life-space group, 49.5% (n = 49) had restricted life-space at 90-day follow-up. Baseline restricted life-space was associated with greater odds of 90-day hospital readmission (unadjusted OR = 1.64, 95% CI = 1.00-2.70, P = .05; adjusted OR = 1.72, 95% CI = 1.04-2.85, P = .03). CONCLUSION: Baseline restricted life-space was associated with greater risk of hospital readmission within 90 days after hospital discharge. These findings suggest a need to customize the management of individuals hospitalized with CHF or COPD based on baseline life-space level.
RCT Entities:
OBJECTIVES: To describe the association between restricted life-space and characteristics of community-dwelling adults hospitalized for congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD), to estimate the effect of hospitalization on postdischarge mobility, and to determine whether baseline restricted life-space predicts hospital readmission. DESIGN: Observational. SETTING: Urban academic hospital that serves as a safety net for urban and rural populations with low resources and serves central and northern Alabama. PARTICIPANTS: Individuals with CHF or COPD hospitalized from home (N = 478). MEASUREMENTS: The Life-Space Assessment (LSA) measures mobility by asking about movement in situations ranging from within one's dwelling to beyond one's town. LSA scores below 60 correspond to "restricted life-space." Baseline LSA scores before admission were measured during an index hospitalization; follow-up LSA scores were determined over the telephone at 90 days. Participant characteristics were examined according to baseline restricted life-space using the chi-square test and Student's t-test. Each characteristic's association with restricted life-space was estimated uisng logistic regression. RESULTS: Of the participants, 372 (77.8%) were classified as having baseline restricted life-space. Baseline restricted life-space was associated with older age (odds ratio (OR) = 1.29 per decade, 95% confidence interval (CI) = 1.17-1.42, P = .001), female sex (OR = 2.69, 95% CI = 1.69-4.29, P < .001), African-American race (OR = 1.55, 95% CI = 1.00-2.41, P = .05), and having inadequate financial resources (OR = 2.03, 95% CI = 1.22-3.38, P = .006). In the baseline unrestricted life-space group, 49.5% (n = 49) had restricted life-space at 90-day follow-up. Baseline restricted life-space was associated with greater odds of 90-day hospital readmission (unadjusted OR = 1.64, 95% CI = 1.00-2.70, P = .05; adjusted OR = 1.72, 95% CI = 1.04-2.85, P = .03). CONCLUSION: Baseline restricted life-space was associated with greater risk of hospital readmission within 90 days after hospital discharge. These findings suggest a need to customize the management of individuals hospitalized with CHF or COPD based on baseline life-space level.
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