Functional trajectories during hospitalization: A prognostic sign for elderly patients

Abstract

Background. Clinicians have used measurements of pathological conditions and functional status to capture the heterogeneity of older individuals for prognostic purposes. However, the literature pays low attention to physical functional changes. Methods. A retrospective cohort study to investigate the association between functional changes during hospitalization and 3-month mortality. A total of 1,119 acutely ill elderly patients admitted to four beds arranged like a high-dependency area in a geriatric unit (mean age 80.6 ± 7.8 years) were subdivided into four groups according to degree of functional decline at admission in comparison with the premorbid level and ability or inability to regain function at discharge: with moderate loss, able to regain (group a) and unable to regain function (group b); and with severe loss, able to regain (group c) and unable to regain function (group d) during hospitalization. Age, gender, cognitive and functional status (basic activities of daily living-[BADL]), serum albumin, Acute Physiology Score, Acute Physiology and Chronic Health Evaluation II score, comorbid conditions, number of drugs, and length of stay were collected. Results. Total 3-month mortality was 17.9%. Mortality rate was 10.7%, 17.6%, 14.5%, and 36.7% in groups a, b, c, and d, respectively. In three different multivariate Cox models including BADLs before admission, at admission, and at discharge, inability to regain function during hospitalization was an independent factor associated with 3-month mortality. Conclusions. In acutely ill elderly patients, lack of function regain during hospitalization is associated with higher mortality rate at 3 months, compared with those capable to regain the baseline functional status. © The Author 2009. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved.