Hospitalization-Associated Disability

Abstract

In older patients, acute medical illness that requires hospitalization is a sentinel event that often precipitates disability. This results in the subsequent inability to live independently and complete basic activities of daily living (ADLs). This hospitalization-associated disability occurs in approximately one-third of patients older than 70 years of age and may be triggered even when the illness that necessitated the hospitalization is successfully treated. In this article, we describe risk factors and risk stratification tools that identify older adults at highest risk of hospitalization-associated disability. We describe hospital processes that may promote hospitalization-associated disability and models of care that have been developed to prevent it. Since recognition of functional status problems is an essential prerequisite to preventing and managing disability, we also describe a pragmatic approach toward functional status assessment in the hospital focused on evaluation of ADLs, mobility, and cognition. Based on studies of acute geriatric units, we describe interventions hospitals and clinicians can consider to prevent hospitalization-associated disability in patients. Finally, we describe approaches clinicians can implement to improve the quality of life of older adults who develop hospitalization-associated disability and that of their caregivers.

Sarcopenia and sarcopenic leg as potential risk factors for acute osteoporotic vertebral fracture among older women

“…In further study, we would use muscle strength and physical performance as the independent variables to determine the association between sarcopenia and OVF. Recent reports have mentioned that bed rest and low energy intake among inpatients may cause sarcopenia and hospitalization-associated disability [38]. However, the present study estimated muscle mass within 48 h of admission; thus, the effect of bed rest was limited.…”

Determining clinical practice of expert physiotherapy for patients undergoing lumbar spinal fusion: a cross-sectional survey study

“…Through the use of protocols, physiotherapists who are unfamiliar with working practices in other departments, can still deliver care as best as possible. Unfortunately, these protocols carry the risk that all therapists will deliver protocolised and therapist centred (one-size-fits-all) care instead of the currently favoured patient centred and personalised care [13,14], as demonstrated by the high number of expert therapists using protocols to guide their day-to-day practice therapy in our study. We specifically included expert physiotherapists in our survey population to distil best (physiotherapy) practice in LSF [13,14].…”

“…Unfortunately, these protocols carry the risk that all therapists will deliver protocolised and therapist centred (one-size-fits-all) care instead of the currently favoured patient centred and personalised care [13,14], as demonstrated by the high number of expert therapists using protocols to guide their day-to-day practice therapy in our study. We specifically included expert physiotherapists in our survey population to distil best (physiotherapy) practice in LSF [13,14]. Interestingly, we found that factors essential for clinical reasoning (such as functional diagnosis) were often not evaluated, therapy was either never or always provided (regardless of the patient's need), and therapy was typically delivered on time-based principles (not goal-based).…”

Ethical Considerations of Quality Improvement and Human Subjects Research: Is There a Slippery Slope?

“…Further, when immobility exists, patients of all ages are at risk for immobility-related adverse outcomes, many of which are non-reimbursable, as indicated by the Centers for Medicare and Medicaid Services. 19,20 Hazards of immobility that affect all hospitalized patients may include ventilator associated pneumonia (VAP), atelectasis, delayed extubation, peristaltic impairment, wound infections, depression, social isolation, embolic conditions, urinary tract infection, extended or repeated lengths of stay, and avoidable or unavoidable pressure ulcers. 21 The inability to reposition patients adequately is a significant concern, especially among obese, disabled, critical care, trauma, neurologic, or orthopedic patients.…”