Disability and Recovery After Hospitalization for Medical Illness Among Community-Living Older Persons: A Prospective Cohort Study

Abstract

Objectives: To determine for each basic, instrumental, and mobility activity after hospitalization for acute medical illness: (1) disability prevalence immediately before and monthly for 6 months after hospitalization; (2) disability incidence 1 month after hospitalization; and (3) recovery time from incident disability during months 2 to 6 after hospitalization.

Design: Prospective cohort study.

Setting: New Haven, Connecticut.

Participants: A total of 515 community-living persons, mean age 82.7 years, hospitalized for acute noncritical medical illness and alive within 1 month of hospital discharge.

Measurements: Disability was defined monthly for each basic (bathing, dressing, walking, transferring), instrumental (shopping, housework, meal preparation, taking medications, managing finances), and mobility activity (walking a quarter mile, climbing flight of stairs, lifting/carrying 10 pounds, driving) if help was needed to perform the activity or if a car was not driven in the prior month.

Results: Disability was common 1 and 6 months after hospitalization for activities frequently involved in leaving the home to access care including walking a quarter mile (prevalence 65% and 53%, respectively) and driving (65% and 61%). Disability was also common for activities involved in self-managing chronic health conditions including meal preparation (53% and 41%) and taking medications (41% and 31%). New disability was common and often prolonged. For example, 43% had new disability walking a quarter mile, and 30% had new disability taking medications, with mean recovery time of 1.9 months and 1.7 months, respectively. Findings were similar for the subgroup of persons residing at home (ie, not in a nursing home) at the first monthly follow-up interview after hospitalization.

Conclusion: Disability in specific functional activities important to leaving home to access care and self-managing health conditions is common, often new, and present for prolonged time periods after hospitalization for acute medical illness. Post-discharge care should support patients through extended periods of vulnerability beyond the immediate transitional period. J Am Geriatr Soc 68:486-495, 2020.

Keywords: disability; function; geriatrics; hospital care; transitional care.

Figure 1

Prevalence of disability before and after hospitalization for acute medical illness for each basic, instrumental, and mobility activity. Data on disability were collected during monthly telephone interviews. Disability was defined for each basic (bathing, dressing, walking across a room, transferring from a chair), instrumental (shopping, housework, meal preparation, taking medications, managing finances), and mobility activity (walking a quarter mile, climbing a flight of stairs, lifting or carrying 10 pounds) if help was needed from another person to perform the activity. Disability was defined for driving if the participant did not drive a car in the month preceding the interview. The number of participants contributing data was 515 in the month before hospitalization and 515, 499, 489, 481, 478, and 472 during months 1 through 6 after hospital discharge, respectively. Data for basic activities are shown in panel A, instrumental activities in panel B, and mobility activities in panel C.

Figure 2

Proportion newly disabled at 1 month after hospitalization for acute medical illness for each basic, instrumental, and mobility activity. We calculated the incidence proportion of disability in each basic, instrumental, and mobility activity comparing the month after hospitalization with the month before hospitalization in panels A, B, and C, respectively.

Figure 3

Cumulative probability of recovery after hospitalization for acute medical illness for each basic, instrumental, and mobility activity. We used Kaplan-Meyer survival curves to evaluate time to recovery for each activity among incident disability cases at the first monthly interview after hospitalization with follow-up starting from month 2 after hospitalization. The cumulative probability of recovery for each activity was estimated after accounting for censoring due to mortality and loss to follow-up. Data for basic, instrumental, and mobility activities are shown in panels A, B, and C, respectively. Error bars denote standard deviations.