The Natural History of Functional Morbidity in Hospitalized Older Patients

Abstract

This study provides data on changes in the functional status of older patients that are associated with acute hospitalization. Seventy-one patients over the age of 74 admitted to the medical service of Stanford University Hospital between February and May 1987 received functional assessments covering seven domains: mobility, transfer, toileting, incontinence, feeding, grooming, and mental status. Assessments were obtained by report from the patient's caregiver (or the patient when he or she lived alone) for 2 weeks before admission; from the patient's nurse on day 2 of hospitalization and on the day before discharge; and again from the caregiver (or patient) 1 week after discharge. The sample had a mean age of 84, covered 37 Diagnostic Related Groups, and had a median length of stay of 8 days. Between baseline and day 2, statistically significant deteriorations occurred for the overall functional score and for the individual scores for mobility, transfer, toileting, feeding, and grooming. None of these scores improved significantly by discharge. In the case of mobility, 65% of the patients experienced a decline in score between baseline and day 2. Between day 2 and discharge, 67% showed no improvement, and another 10% deteriorated further. These data suggest that older patients may experience a burden of new and worsened functional impairment during hospitalization that improves at a much slower rate than the acute illness. An awareness of delayed functional recovery should influence discharge planning for older patients. Greater efforts to prevent functional decline in the hospitalized older patient may be warranted.

Impacto funcional da internação hospitalar de pacientes idosos

“…Não houve associação entre a faixa etária e a capacidade funcional, contrariando a literatura, 6,14,16,23 o que pode ser explicado pela elevada incapacidade referida pelos idosos entrevistados no presente estudo, no momento da entrada no hospital. Alguns autores, 5,6 apói-am o uso das medidas funcionais retrospectivas em pacientes idosos hospitalizados, a exemplo do presente estudo cuja medida da capacidade funcional foi realizada por meio de relatos retrospectivos, ou seja, em relação aos 30 dias que antecederiam a hospitalização.…”

“…20 Na maioria dos estudos estrangeiros, a variação é de oito a 15 dias de hospitalização. 14,16 Além do número elevado de dias de internação, suficientes para a verificação de declínios funcionais, verificou-se associação significante entre os maiores comprometimentos funcionais e maiores dias de hospitalização. Percebendo a importância dessa variável como indicadora de qualidade de serviços hospitalares, institucionalização e dependência funcional, alguns estudos 18,22 têm-se dedicado a acompanhar mais de perto esses resultados.…”

“…6 Os idosos são mais suscetíveis a complicações causadas pelo repouso prolongado no leito durante a hospitalização. 14 Alguns estudos têm avaliado, de maneira ampla, os riscos a que estão sujeitos os pacientes hospitalizados. 16 Nas últimas décadas, tem sido foco de atenção a importância desses problemas, tendo em vista suas complicações médicas, sociais e políticas.…”

Community‐Acquired Pneumonia in Older Veterans: Does the Pneumonia Prognosis Index Help?

“…5 Functional decline occurs quickly upon hospitalization and often fails to improve after discharge. 6,7 Recently several studies have been performed to define pathways of care for individuals with community-acquired pneumonia (CAP). Fine et al developed a disease-severity model, the Pneumonia Prognosis Index (PPI), based on mortality.…”

Electrical stimulation versus kinesitherapy in improving functional fitness in older women: A randomized controlled trial

“…Long-stay hospitalized old patients frequently develop a rapid decrease in muscular strength, cardiovascular fitness and balance, as reported in many observational studies (Gillick et al, 1982;Warshaw et al, 1982;Hirsch et al, 1990;Inouye et al, 1993). Such a decline is usually a consequence of limited physical activity (Gillick et al, 1982;Creditor, 1993;Inouye et al, 1993) and occurs early, within a few days after the admission (Lazarus et al, 1991), regardless of the underlying pathology.…”