[Functional deterioration secondary to hospitalization for an acute disease in the elderly. An analysis of its incidence and the associated risk factors]

Abstract

Objective: To determine the incidence of functional impairment at hospital admission and after hospital discharge, and to identify those factors that could be predictors of such impairment in a cohort of elderly people with high level of independence in the basic activities of daily living (BADL).

Design: Epidemiologic, longitudinal and prospective study.

Setting: Acute unit in a geriatric department.

Subjects: The follow-up population was made up by 150 subjects older than 65 years, admitted on account of acute medical conditions from December, 15th, 1995, to December, 15th, 1996, who were independent for walking and independent or with slight dependence for BADL. STUDY PARAMETERS: All patients were evaluated at 48 hours after admission and one month after discharge by means of a protocol including sociodemographic, clinical, attending, functional and mental parameters.

Results: The incidence of functional impairment at hospital admission was 70.66%; such impairment persisted one month after discharge in 29.3% of subjects. The most involved activities related to motility. In the analysis of crude data, the following parameters showed association with functional impairment risk one month after discharge: female sex (OR: 2.5), sensorial organ pathology (OR: 2.6), hospital stay longer than 15 days (OR: 7.2), and Lawton Index score (3.8 +/- 2.6 in impaired patients vs. 4.9 +/- 2 in non-impaired patients; p < 0.01). Barthel Index score at admission lower than 60 (OR: 9.5), Cognitive Miniexam score lower than 28 (OR: 4.1), Informant Test score higher than 84 (OR: 2.5) and Geriatric Depression Scale score 9 (OR: 3.1). In the logistic regression model, the following parameters remained as predictors of impairment: sex (OR: 3.3), days of hospital stay (OR: 2.3) and Barthel Index score at admission (OR: 6.1) and Cognitive Miniexam score (OR: 2.7).

Conclusions: For our population, sex, hospital stay days, functional impairment in Barthel Index at admission and Cognitive Miniexam score parameters seem to behave as independent variables that can predict functional impairment risk for BADL one month after discharge. These parameters could be useful to select groups of elderly people with impairment risk, who could benefit from specialized interventions leading to prevent/decrease functional impairment secondary to acute disease and hospitalization.