Physical Function and Disability After Acute Care and Critical Illness Hospitalizations in a Prospective Cohort of Older Adults

Abstract

Objectives To investigate associations between acute care and critical illness hospitalizations and performance on physical functional measures and activities of daily living (ADLs). Design Prospective cohort study. Setting Large health maintenance organization. Participants 2926 Participants in Adult Changes in Thought, a study of aging enrolling dementia-free individuals aged 65 and older not living in a nursing home from 1994 to September 30, 2008 (N=2,926). Measurements The exposure of interest was hospitalization during study participation, subdivided by presence of critical illness. Outcomes included gait speed, grip strength, chair stand speed, and difficulty and dependence in performing ADLs measured at biennial visits. Results Median time between hospital discharge and the next study visit was 311 days (interquartile range (IQR) 151–501 days) after acute care hospitalization and 359 days (IQR 181–420 days) after critical illness hospitalization. Gait speed was slower after acute care (–0.05 m/s, 95% confidence interval (CI)=0.01–0.04 m/s slower, P< .001) and critical illness (–0.16 m/s, 95% CI=–0.22 to –0.10, P< .001). Grip was weaker after acute care hospitalization (–0.8 kg, 95% CI=–1.0 to –0.6, P<.001) but not significantly different after critical illness hospitalization. Chair-stand speed was slower after acute care hospitalization (–0.04 stands/s, 95% CVI=–0.05 to –0.04, P< .001) and critical illness hospitalization (–0.09, 95% CI=–0.15 to –0.03, P=.003). The odds of difficulty with (odds ratio (OR)=1.4, 95% CI=1.2–1.6, P<.001) or dependence in (OR=2.0, 95% CI=1.2–3.2, P=.006) one or more ADLs was higher after acute care hospitalization, as were the odds of difficulty with (OR=1.9, 95% CI=1.1–3.6, P=.03) or dependence in (OR=7.9, 95% CI=2.5–25.7, P=.001) one or more ADLs after critical illness. Conclusion In older adults, hospitalization, especially for critical illness, was associated with clinically relevant decline in gait and chair stand speed and strongly associated with difficulty with and dependence in ADLs.

Lung injury-induced skeletal muscle wasting in aged mice is linked to alterations in long chain fatty acid metabolism

“…Increasing evidence suggests that neuromuscular weakness developing from critical illness is independently associated with morbidity and mortality, and is therefore an attractive therapeutic target (Ali et al 2008; Hermans et al 2014). While it has been suggested that older patients exhibit increased the severity of ICU acquired neuromuscular weakness, this has been understudied and the mechanisms are unknown (Ehlenbach et al 2015; Ely et al 2002; Ferrante et al 2015; Ferrante et al 2016). In this manuscript, we present a model of an age-associated increase in mortality from lung injury, coupled with prolonged neuromuscular dysfunction.…”

“…Older ARDS patients also have profound functional impairment following severe critical illness, suggesting that ICU acquired neuromuscular dysfunction may be more severe in older patients (Ehlenbach et al 2015; Ely et al 2002; Ferrante et al 2015). The etiologies for these potential age-associated disparities in ICU acquired neuromuscular dysfunction in ARDS are unknown, but may relate to the underlying loss of muscle mass and function (sarcopenia) associated with aging (Cruz-Jentoft et al 2010).…”

Defining Patient Centric Pharmaceutical Drug Product Design

“…This risk is increased when restrictions or special dosing requirements are present, be such a dosing with or without food. Moreover, patients with multi-morbidity and increased healthcare needs are also at higher risk of functional and cognitive impairments, further reducing their capability in managing complex tasks (7)(8)(9).…”

Characteristics and provision of care of patients with the acute respiratory distress syndrome: descriptive findings from the DACAPO cohort baseline and comparison with international findings

“…The latter observation is completely in accordance to other cohorts of ARDS patients listed in Table S1 and emphasizes the role of male sex as risk factor for heart and lung diseases in general and ARDS in particular. The finding of a high proportion of elderly patients is highly relevant, since old patients surviving a critical illness are at high risk for long-term physical and cognitive impairment (27) requiring prolonged care of the families and of the medical system (28). It must be determined in further health care studies, whether elderly patients receive adequate care after survival of ARDS.…”