Hospital‐Associated Functional Decline: The Role of Hospitalization Processes Beyond Individual Risk Factors. Issue 1 (January 2015)

• Record Type: Journal Article
• Authors: Zisberg, Anna; Shadmi, Efrat; Gur‐Yaish, Nurit; Tonkikh, Orly; Sinoff, Gary
• Is Part Of: Journal of the American Geriatrics Society. Volume 63:Issue 1(2015:Jan.)
• Page Start: 55
• Page End: 62
• Publication Date: 2015-01
• Subjects: Geriatrics -- Periodicals; 618.97
• DOI: 10.1111/jgs.13193
• Languages: English
• ISSNs: 0002-8614

Abstract

<abstract abstract-type="main" id="jgs13193-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="jgs13193-sec-0001" sec-type="section"> <title>Objectives</title> <p>To investigate the combined contribution of processes of hospitalization and preadmission individual risk factors in explaining functional decline at discharge and at 1‐month follow‐up in older adults with nondisabling conditions.</p> </sec> <sec id="jgs13193-sec-0002" sec-type="section"> <title>Design</title> <p>Prospective cohort study.</p> </sec> <sec id="jgs13193-sec-0003" sec-type="section"> <title>Setting</title> <p>Internal medicine wards in two Israeli medical centers.</p> </sec> <sec id="jgs13193-sec-0004" sec-type="section"> <title>Participants</title> <p>Six hundred eighty‐four individuals aged 70 and older admitted for a nondisabling problem.</p> </sec> <sec id="jgs13193-sec-0005" sec-type="section"> <title>Measurements</title> <p>Functional decline was measured according to change in modified Barthel Index from premorbid to discharge and from premorbid to 1 month after discharge. In‐hospital mobility, continence care, sleep medication consumption, satisfaction with hospital environment, and nutrition intake were assessed using previously tested self‐report instruments.</p> </sec> <sec id="jgs13193-sec-0006" sec-type="section"> <title>Results</title> <p>Two hundred eighty‐two participants (41.2%) reported functional decline at discharge and 317 (46.3%) at 1 month after discharge. Path analysis indicated that in‐hospital mobility (standardized maximum likelihood estimate (SMLE) = −0.48, <italic>P</italic> < .001), continence care (SMLE = −0.12, <italic>P</italic> < .001), and length of stay (LOS) (SMLE = 0.06, <italic>P</italic> < .001) were directly related to functional decline at discharge and, together with personal risk factors, explained 64% of variance. In‐hospital mobility, continence care, and LOS were indirectly related to functional decline at 1 month after discharge through functional decline at discharge (SMLE = 0.45, <italic>P</italic> < .001). Nutrition consumption (SMLE = −0.07, <italic>P</italic> < .001) was significantly related to functional decline at 1 month after discharge, explaining, together with other risk factors, 32% of variance.</p> </sec> <sec id="jgs13193-sec-0007" sec-type="section"> <title>Conclusion</title> <p>In‐hospital low mobility, suboptimal continence care, and poor nutrition account for immediate and 1‐month posthospitalization functional decline. These are potentially modifiable hospitalization risk factors for which practice and policy should be targeted in efforts to curb the posthospitalization functional decline trajectory.</p> </sec> </abstract>