Low intrinsic capacity, delirium, and urinary incontinence are associated with poor trajectories of activities of daily living in older patients after discharge

Abstract

Introduction: Intrinsic capacity (IC), which includes locomotion, vitality, cognition, sensation, and psychology, is key to healthy aging. Few studies have focused on the association between IC and trajectory of activities of daily living (ADL) in hospitalized older patients. This study aimed to investigate the effect of IC and coexisting variables on ADL trajectory in older patients after discharge.

Methods: A secondary analysis was conducted using a comprehensive geriatric assessment database in a tertiary care medical center in southern Taiwan. The baseline data collected at admission included demographic factors, present health conditions, and IC. The Barthel Index score at one, three, six, and 12 months after discharge were evaluated as outcomes.

Results: This study included 558 patients with a mean age of 84.6±7.6 years, and 61.3 % were men. On average, their mean score of IC was 1.76±0.79, and 96.4 % had locomotor impairment, 95 % had vitality problems, 93.9 % had sensory problems, 60 % had cognitive impairment, and 55.2 % had psychological issues. Latent profile analysis was used to classify ADL trajectory in older patients after discharge into three classes: improved, slightly improved, and declining. Higher IC scores, lower prevalence of delirium, and fewer urinary incontinence issues were associated with membership in the improved and slightly improved groups.

Conclusion: Low IC, delirium, and urinary incontinence are associated with poorer post-discharge ADL trajectories in older patients. Early identification of these risk factors can guide nurses in implementing individualized care plans to support recovery and promote independence in older patients.

Keywords: Activity of daily living; Delirium; Intrinsic capacity; Older patients; Urinary incontinence.