Physical function of elderly patients with multimorbidity upon acute hospital admission versus 3 weeks post-discharge

Abstract

Purpose: To evaluate the change in activities of daily living, grip strength and functional mobility in very old patients >75 years old with multimorbidity upon admission to hospital versus 3 weeks after discharge. A second aim was to explore which baseline variables could predict personal activities of daily living 3 weeks after discharge.

Methods: This prospective cohort study included 115 home-dwelling older adults (mean 86 years, standard deviation 5.9). Participants were measured with the Timed Up and Go, grip strength and Barthel Index in hospital (T1) and 3 weeks after discharge (T2).

Results: After 3 weeks, the participants had significantly improved their activities of daily living, mobility and muscle strength, but were still physically reduced compared to reference values for age-matched elderly home dwellers and were at high risk of falls and further loss of independence. In the multivariate regression analysis, baseline cognitive function and mobility were independently associated with Barthel Index at T2 and explained 47% of the variance three weeks after discharge.

Conclusions: Our findings highlight the importance of applying performance-based assessments for elderly in hospital. The result indicates that frail old adults acutely admitted to hospital are in need of rehabilitation 3 weeks after hospitalization. Implications for Rehabilitation Older people with multimorbidity improve their physical function 3 weeks after hospitalization. Nevertheless, they still are physically reduced with respect to reference values for age-matched elderly home dwellers and far below the cutoff score for their risk of falls, continued health decline and loosing their independence. The results imply that older people with multimorbidity are in need of early rehabilitation program during hospitalization and after hospitalization. The use of performance-based measurements enables us to identify older adults at highest risk of decline in health and function and is a key of identifying frail older peoples need for rehabilitation. The Time up and Go test, Grip Strength test and the Barthel Index are considered to complement each other and regarded as useful assessments for frail older people in hospital with acute illness.

Keywords: Activities of daily living; acute hospitalization; frail; grip strength; mobility; older adults; physical performance; physiotherapy.