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Observational Study
. 2021 Mar;69(3):696-703.
doi: 10.1111/jgs.16950. Epub 2020 Dec 8.

Persistent Functional Decline Following Hospitalization with Influenza or Acute Respiratory Illness

Melissa K Andrew  1   2 , Sarah MacDonald  3 , Judith Godin  1 , Janet E McElhaney  4 , Jason LeBlanc  2   5 , Todd F Hatchette  2   6 , William Bowie  7 , Kevin Katz  8 , Allison McGeer  9 , Makeda Semret  10 , Shelly A McNeil  2   6
Affiliations
Observational Study

Persistent Functional Decline Following Hospitalization with Influenza or Acute Respiratory Illness

Melissa K Andrew et al. J Am Geriatr Soc. 2021 Mar.

Abstract

Background/objectives: Influenza is associated with significant morbidity and mortality, particularly for older adults. Persistent functional decline following hospitalization has important impacts on older adults' wellbeing and independence, but has been under-studied in relation to influenza. We aimed to investigate persistent functional change in older adults admitted to hospital with influenza and other acute respiratory illness (ARI).

Design: Protective observational cohort study.

Setting: Canadian Immunization Research Network Serious Outcomes Surveillance Network 2011 to 2012 influenza season.

Participants: A total of 925 patients aged 65 and older admitted to hospital with influenza and other ARI.

Measurements: Influenza was laboratory-confirmed. Frailty was measured using a Frailty index (FI). Functional status was measured using the Barthel index (BI); moderate persistent functional decline was defined as a clinically meaningful loss of ≥10 to <20 points on the 100-point BI. Catastrophic disability (CD) was defined as a loss of ≥20 points, equivalent to full loss of independence in two basic activities of daily living.

Results: Five hundred and nineteen (56.1%) were women; mean age was 79.4 (standard deviation=8.4) years. Three hundred and forty-six (37.4%) had laboratory-confirmed influenza. Influenza cases had lower baseline function (BI = 77.0 vs 86.9, P < .001) and higher frailty (FI = 0.23 vs 0.20, P < .001) than those with other ARI. A total of 8.4% died, 8.2% experienced persistent moderate functional decline, and 9.9% experienced CD. Higher baseline frailty was associated with increased odds of experiencing functional decline, CD, and death. The experience of functional decline and CD, and its association with frailty, was the same for influenza and other ARI.

Conclusion: Functional loss in hospital is common among older adults; for some this functional loss is persistent and catastrophic. This highlights the importance of prevention and optimal management of acute declines in health, including influenza, to avoid hospitalization. In the case of influenza, for which vaccines exist, this raises the potential of vaccine preventable disability.

Keywords: activities of daily living; aged; frail elderly; hospitalization; influenza.

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Conflict of interest statement

MKA reports grant payments to her institution from the Canadian Frailty Network, Sanofi Pasteur and GSK group of companies for the conduct of this study, and payments and grant funding from the GSK group of companies, Pfizer and Sanofi Pasteur, outside the submitted work. SM and JG report no conflicts. JEM reports payments to her institution from GlaxoSmithKline, Merck, Sanofi, Pfizer, Medicago, and RestorBio outside of the submitted work. JL reports payments to his institution from the GSK group of companies for the conduct of this study, and payments from Pfizer and Merck outside of the submitted work. TFH reports payments from the GSK and Pfizer group of companies, during the conduct of the study. WB has nothing to disclose. KK has nothing to disclose. AM reports payments to her institution from the GSK group of companies for the conduct of this study, and payments from GSK, Seqirus and Sanofi Pasteur, outside the submitted work. MS reports payments from the GSK group of companies and Pfizer, during the conduct of the study. SAM reports payments from the GSK group of companies, during the conduct of the study; and reports payments from Pfizer, GSK, Merck, Novartis, and Sanofi, outside the submitted work.

Figures

Figure 1
Figure 1
Patient outcomes, subdivided by laboratory‐confirmed influenza versus other influenza acute respiratory illness (ARI). Percentages are presented for the overall cohort and within the influenza and other ARI groups.
See this image and copyright information in PMC

References

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