Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Apr;21(4):455-461.e5.
doi: 10.1016/j.jamda.2019.09.015. Epub 2019 Nov 14.

Prevalence of Hospital-Associated Disability in Older Adults: A Meta-analysis

Christine Loyd  1 , Alayne D Markland  2 , Yue Zhang  3 , Mackenzie Fowler  4 , Sara Harper  3 , Nicole C Wright  4 , Christy S Carter  3 , Thomas W Buford  3 , Catherine H Smith  5 , Richard Kennedy  1 , Cynthia J Brown  1
Affiliations
Review

Prevalence of Hospital-Associated Disability in Older Adults: A Meta-analysis

Christine Loyd et al. J Am Med Dir Assoc. 2020 Apr.

Abstract

Objectives: Hospital-associated disability (HAD), defined as loss of independence in activities of daily living (ADL) following acute hospitalization, is observed among older adults. The study objective is to determine overall prevalence of HAD among older adults hospitalized in acute care, and to assess the impact of study initiation year in moderation of prevalence.

Design: Meta-analysis of data collected from randomized trials, quasi-experimental, and prospective cohort studies. English-language searches to identify included studies were completed February 2018 and updated May 2018 of electronic databases and reference lists of studies and reviews. Included studies were human subjects investigations that measured ADL ≥2 time points before or during and after hospitalization and reported prevalence of ADL decline among older adults.

Setting: Acute care hospital units.

Participants: Adults aged ≥65 years hospitalized in medical-surgical acute care; total sample size across all included studies was 7375.

Methods: Independence in ADL was assessed using the Katz Index of Independence in Activities of Daily Living and Barthel Index of Independence in Activities of Daily Living.

Results: Random effects meta-analysis across included studies identified combined prevalence of HAD as 30% (95% CI 24%, 33%; P < .001). The effect of study initiation year on the prevalence rate was minimal. A large amount of heterogeneity was observed between studies, which may be due in part to nonstandardized measurement of ADL impairment or other methodological differences.

Conclusions and implications: Hospitalization in acute care poses a significant risk to functional independence of older adults, and this risk is unchanged despite shorter lengths of stay. The evidence supports the continued need for hospital-based programs that provide assessment of functional ability and identification of at-risk older adults in order to better treat and prevent HAD.

Keywords: Hospitalization; activities of daily living; disability; older adult.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest

CL, MEF, YZ, MF, SH, NCW, CSC, TWB, CHS, REK, and CJB have no perceived conflicts of interest to declare.

Figures

Figure 1.
Figure 1.
PRISMA flow diagram for included studies.
Figure 2.
Figure 2.. Forest plot of the prevalence of hospital-associated disability (HAD): hospital-based studies only.
Prevalence rates from 13 individual hospital-based studies were combined using random-effects meta-analysis with a generalized linear mixed model. Vertical reference line indicates prevalence rate of 0 (no HAD); size of squats is proportional to the weight of the study in the analysis. CI=confidence interval.
Figure 3.
Figure 3.. Cumulative meta-analysis of all included studies showing time as a moderator of prevalence of hospital-associated disability (HAD).
Prevalence rates were estimated after the addition of each study in chronological order of study initiation year to examine changes in prevalence over time. Vertical reference line indicates prevalence rate of 0 (no HAD).
See this image and copyright information in PMC

References

    1. Brown CJ, Friedkin RJ, Inouye SK. Prevalence and outcomes of low mobility in hospitalized older patients. J Am Geriatr Soc. 2004;52(8):1263–1270. - PubMed
    1. Gill TM, Allore HG, Gahbauer EA, Murphy TE. Change in disability after hospitalization or restricted activity in older persons. JAMA. 2010;304(17):1919–1928. - PMC - PubMed
    1. Gill TM, Allore HG, Holford TR, Guo Z. Hospitalization, restricted activity, and the development of disability among older persons. JAMA. 2004;292(17):2115–2124. - PubMed
    1. McVey LJ, Becker PM, Saltz CC, Feussner JR, et al. Effect of a geriatric consultation team on functional status of elderly hospitalized patients. A randomized, controlled clinical trial. Ann Intern Med. 1989;110(1):79–84. - PubMed
    1. Lamont CT, Sampson S, Matthias R, Kane R. The outcome of hospitalization for acute illness in the elderly. J Am Geriatr Soc. 1983;31(5):282–288. - PubMed

Publication types