Is prehospital physical performance a predictor of functional capacity decline at discharge in hospitalized Brazilian older adults?

Abstract

Background: Hospitalization contributes to functional decline in older adults.

Objective: To assess the relationship between physical performance on admission and functional capacity and functional capacity decline at discharge, and to investigate tools capable of predicting this decline.

Methods: Prospective longitudinal study with 75 older adults admitted to a public hospital between July 2021 and February 2022. The independent variable was physical performance evaluated on admission by handgrip strength (HGS) and the Short Physical Performance Battery (SPPB). The dependent variables were functional capacity for basic activities of daily living (BADLs) and instrumental activities of daily living (IADLs) and their decline between admission and discharge. Statistical analyses were performed using linear and logistic regression and ROC curves.

Results: The median time between admission and participant assessment was 1 day (IQR=1-2 days). Median hospitalization time was 18 days (IQR= 7.5-30 days). Functional capacity for BADLs and IADLs declined in 39% and 79% of the participants, respectively. Performance in HGS and the SPPB at baseline, in adjusted models, explained 29.3 to 35.3% of functional capacity at discharge. One additional point in the SPPB decreased the risk of functional capacity decline for BADLs by 20.9% (OR=0.79, 95% CI: 0.68, 0.91). The AUC values for the SPPB (AUC=0.67) and HGS (AUC=0.65) were significant in identifying functional decline for BADLs, but not IADLs.

Conclusion: In Brazilian older adults, physical performance on admission was related to functional capacity and its decline at discharge. Physical performance on admission is predictive of functional decline at discharge.

Keywords: Activities of daily living; Aged; Functional assessment; Hospital; Physical therapy.

Fig. 1

Flowchart of participant selection and monitoring. HGS, handgrip strength; SPPB, Short Physical Performance Battery.

Fig. 2

ROC curves for identifying functional decline at discharge. AUC, area under the ROC curve, BADLs, Basic activities of daily living; IADLs, Instrumental activities of daily living; HGS, handgrip strength (kgf); SPPB, Short Physical Performance Battery (total score).