Preventable Iatrogenic Disability in Elderly Patients During Hospitalization

Sourdet, Sandrine; Lafont, C.; Rolland, Yves; Nourhashémi, Fati; Andrieu, Sandrine; Vellas, Bruno

doi:10.1016/j.jamda.2015.03.011

Cited by 128 publications

(106 citation statements)

References 31 publications

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“…The causes of functional loss in hospitalized elderly persons are multifactorial and cumulative and include factors such as the cause of hospitalization; advanced age 4,26 ; entry diagnosis; previous functional situation; bed rest (resulting in decreased mobility); medical procedures; medicines; cognitive deficit; an acute confusional state and malnutrition 16,18 . There is great variability in the studies in terms of the evaluation of the elderly based on the location of hospitalization: geriatric wards 16 and general hospital 5 , reassessment three months after hospital discharge 20 , the use of indexes of comorbidity and evaluation of instrumental activities of daily living 2,3,26 .…”

Section: Discussionmentioning

confidence: 99%

“…During hospitalization the elderly can experience loss of functional capacity, which may be due to the disease that determined the hospitalization, previous clinical conditions, the procedures to which the elderly person is subjected, the poor adaptation of the health system to aging and to frailty [2][3][4] . This condition is known as hospital acquired disability (HAD) 5 and can affect from 30 to 60% of hospitalized elderly persons 2,6 .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Impact of hospitalization on the functional capacity of the elderly: A cohort study

Carvalho

Valle

Jacinto

et al. 2018

Rev. bras. geriatr. gerontol.

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Objective: To verify the trajectory of the functional capacity of elderly persons hospitalized due to clinical conditions in a university hospital. Method: A descriptive, prospective cohort study was conducted between 2015 and 2016. Elderly patients admitted to the Hospital das Clínicas of Botucatu Medical School (Unesp), Brazil, were evaluated for the functional assessment of basic activities of daily living (BADL) using the Katz scale, nutritional status (body mass index (BMI)) and presence of the Frailty Syndrome (FS) (Fried criteria). A description of the trajectory of functional capacity was carried out at four times: 15 days before admission (T0), at admission (T1), at hospital discharge (T2) and 30 days after discharge (T3). Results: 99 elderly people with a mean age of 74 (+7.35) years, 59.6% of whom were male, were evaluated. Of these, 81.8% presented functional independence at T0, 45.5% at T1, 57.6% at T2 and 72.8% at T3. According to their functional trajectories, 28.2% of the elderly lost functional capacity between T0 and T3. There was an association between worsening of functional capacity between T0 and T3 and the FS (RR 4.56; p=0.003). Conclusion: Elderly patients have worse functional capacity at hospital discharge than before hospitalization. About 28.0% of the elderly had worse functional capacity 30 days after discharge than 15 days before admission. The elderly with Frailty Syndrome have a greater risk for worse functional capacity results 30 days after discharge.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of hospitalization on the functional capacity of the elderly: A cohort study

Carvalho

Valle

Jacinto

et al. 2018

Rev. bras. geriatr. gerontol.

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“…Durch Kräfteverlust der unteren Extremitäten, Reduktion der Ausdauer-und kardiopulmonalen Funktionsfähigkeit führt die postoperative Bettruhe zu einem zunehmenden Verlust der körperlichen Funktionsfä-higkeit, was in der angelsächsischen Literatur auch als "hospitalization associated disability" bezeichnet wird [3]. Es wird angenommen, dass dieses Phänomen iatrogen bedingt ist, dem vorgebeugt werden kann [4]. Damit gefährdete Patienten nicht unterhalb der kritischen Schwelle (die körperliche Funktionsfähigkeit ist zu niedrig, um sich ohne Komplikationen von einem chirurgischen Eingriff zu erholen) geraten, ist ein präoperatives Screeningprogramm unentbehrlich.…”

Section: Verbesserung Des Prä-und Postoperativen Behandlungskonzepts unclassified

“…Hierbei erklärt der schulende Physiotherapeut u. a. die ungünstigen Auswirkungen der Bettruhe auf die funktionelle Leistungsfähigkeit, die weitestgehend vermieden werden sollte [25], sowie die Bedeutung einerschnellenMobilisierung [26] und der körperlichen Aktivität [4,7]. Zudem wird Hochrisikopatienten mit niedrigem Aktivitätsniveau empfohlen, an der präoperativen Trainingstherapie teilzunehmen, damit sie den negativen Einflüssen der Operation, den anästhe-siologischen Prozeduren und den noch sehr restriktiven und patienteninaktivierenden Pflegestandards besser gewachsen sind.…”

Section: Patientenschulungunclassified

Verbesserung des prä- und postoperativen Behandlungskonzepts

Punt

Most

Bongers

et al. 2017

Bundesgesundheitsbl

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“…Covinsky [4] labeled surgical functional decline as ''hospitalization associated disability,'' In accordance with Covinsky, Lawrence Lee stated: ''focusing only on the physical domain and ignoring the other domains will incorrectly describe this patient as 'recovered' from surgery'' [5]. Recently, hospitalization-associated disability has been recognized as an iatrogenic but preventable disorder [6]. Prevention of a complicated (post)operative course and a swift return to an adequate performance of activities of daily living (ADL) and instrumental ADL (IADL) in older patients is mandatory and essential to preserve independent functioning and quality of life.…”

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confidence: 99%