Functional Outcomes of Acute Medical Illness and Hospitalization in Older Persons

Sager, Mark A.; Franke, Todd; Inouye, Sharon K.; Landefeld, C. Seth; Morgan, Tracey; Rudberg, Mark A.; Sebens, H; Winograd, Carol Hutner

doi:10.1001/archinte.1996.00440060067008

Cited by 499 publications

(290 citation statements)

References 26 publications

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“…This could bias the results in either direction: acutely ill patients could overestimate the presence of symptoms and functional limitations before the onset of illness or underestimate these symptoms and limitations. However, previous studies have demonstrated the validity of retrospective reports for assessing functional status before admission to hospital in acutely ill patients 34 35. Finally, one needs to be appropriately cautious in the interpretation of our study findings because of the relatively small number of post-discharge deaths.…”

Section: Discussionmentioning

confidence: 84%

Development of a prognostic index for 90-day mortality in patients discharged after admission to hospital for community-acquired pneumonia

Capelastegui

España²,

Quintana³

et al. 2009

Thorax

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Background: Although patients admitted to hospital for community-acquired pneumonia (CAP) experience substantial short-term mortality following hospital discharge, few studies have focused on identifying factors that predict mortality after admission to hospital in this population. The objective of this study was to develop and validate a prognostic index for 90-day mortality after hospital discharge among patients with CAP. Results: In the derivation cohort, three factors were independently associated with 90-day mortality: preillness functional status, Charlson index (composite measure of co-morbid illnesses) and severity on admission. Mortality at 90 days was 0.7% in the low-risk group, 3.5% in the intermediate-risk group and 17.2% in the highrisk group. In the validation cohort, 90-day mortality in the three groups was 0.6%, 3.9% and 19.6%, respectively. Compared with the low-risk group, the odds ratio for mortality was 43.5 for the high-risk group. The risk categories showed an area under the receiver operating characteristic curve of 0.79 in the derivation cohort and 0.82 in the validation cohort. Conclusions: The prognostic index accurately stratifies patients admitted to hospital for CAP into low-, intermediate-and high-risk groups for 90-day mortality on discharge. The use of this index could help clinicians improve outcomes in this vulnerable population by targeting specific interventions to each group.With more than 5 million cases occurring annually in the USA alone, community-acquired pneumonia (CAP) is a leading cause of hospital admissions as well as morbidity and mortality. Numerous investigations have yielded important information about factors that influence the evolution and treatment of CAP during hospitalisation.

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Section: Discussionmentioning

confidence: 84%

Development of a prognostic index for 90-day mortality in patients discharged after admission to hospital for community-acquired pneumonia

Capelastegui

España²,

Quintana³

et al. 2009

Thorax

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“…Between 25% and 50% of older people who are hospitalised lose some of their functional abilities during their hospital stay (Inouye et al 1993). Furthermore, three months after a hospitalisation, 66% have not regained their previous level of functioning (Boyd et al 2009a, Sager et al 1996, Sager and Rudberg 1998.…”

Section: The Role Of Home Care In Supporting Older Peoplementioning

confidence: 99%

Home care: An opportunity for physiotherapy?

Parsons,

Mathieson,

Parsons

2015

NZJP

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Remaining physically active in later life is critical to maintaining independence in activities of daily living and is a major contributor to overall health status amongst older people. Traditionally a key focus of physiotherapy has been on maintaining functional capacity and mobility. However, the health and disability sector is a constantly evolving entity. Clinicians from a number of disciplines, including physiotherapy, need to be flexible, responsive and innovative and maximise cost benefit for the service funder. Nicholls et al (2009) highlighted the imperative need for physiotherapists to investigate innovative models that align with current and future policy and health care reforms. Over the past 15 years there has been an increased emphasis on supporting older people to remain living at home. This article describes New Zealand and international evidence relating to the optimisation of the potential role of physiotherapy in providing rehabilitation expertise into the provision of Home Care for older people.

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“…It is estimated that one-third of older community-living people do not recover their usual activities of daily living (ADL) independence by the time of discharge. 41,42 In a French multicenter survey, hospital-acquired loss of autonomy in older patients was independently predicted by pre-admission walking difficulties, lack of autonomy, risk of falling, and malnutrition risk. 43 The effects of diabetes have not been tested, but the older patient with T2DM has a higher risk of walking limitations and a history of falling 40 and should be considered at risk for hospital-acquired loss of autonomy.…”

Section: Prevention Of Functional Loss In Hospital and Loss Of Autonomentioning

confidence: 99%

Elderly Patients With Type 2 Diabetes Mellitus-the Need for High-Quality, Inpatient Diabetes Care

Bourdel-Marchasson

Sinclair

2013

Hospital Practice

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Elderly patients (aged > 70 years) with diabetes are at high risk of -hospitalization. We provide a detailed commentary about recent international clinical guidelines and a consensus statement devoted to elderly patients with type 2 diabetes mellitus in the context of hospitalization. In emergency departments, the 4 medication agents associated with the greatest number of patient adverse drug events are warfarin, oral glucose-lowering medications, insulin, and antiplatelet agents, all of which are commonly prescribed in older patients with diabetes. Comprehensive gerontological assessment, including review and, if indicated, discontinuation of all potentially unsafe or inappropriate patient medications should be done upstream to reduce the likelihood of adverse drugs events. Severe infections and ischemic heart disease are also frequent causes of acute admission into hospital in patients aged > 75 years. These patients are also likely to be malnourished and nutritional status should be monitored. Nutritional support, combined with specific products to avoid uncontrolled hyperglycemia must be implemented in patients at risk of malnutrition. Early exercise prescription may help patients maintain physical function and prevent the risk of falling. Clinical guidelines should be applied to achieve safe and effective patient target glucose levels. Insulin should be used earlier for its anabolic properties and patients closely monitored to reduce the risk of hypoglycemia and excessive hyperglycemia. The discharge plan needs to address full medical and social needs along with suitable follow-up to ensure a high level of patient safety.

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Functional Outcomes of Acute Medical Illness and Hospitalization in Older Persons

Cited by 499 publications

References 26 publications

Development of a prognostic index for 90-day mortality in patients discharged after admission to hospital for community-acquired pneumonia

Development of a prognostic index for 90-day mortality in patients discharged after admission to hospital for community-acquired pneumonia

Home care: An opportunity for physiotherapy?

Elderly Patients With Type 2 Diabetes Mellitus-the Need for High-Quality, Inpatient Diabetes Care

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