FUNCTIONAL OUTCOMES OF ACUTE MEDICAL ILLNESS AND HOSPITALIZATION IN OLDER PERSONS

Background: Short-stay hospitalization in older patients is frequently associated with a loss of function, which can lead to a need for post discharge assistance and longer-term institutionalization. Because lit tle is known about this adverse outcome of hospitalization, this study was conducted to (1) determine the discharge and 3-month postdischarg e functional outcomes for a large cohort of older persons hospitalized for medical illness, (2) determine the extent to which patients were able to recover to preadmission levels of functioning after hospital d ischarge, and (3) identify the patient factors associated with an incr eased risk of developing disability associated with acute illness and hospitalization. Methods: A total of 1279 community-dwelling patients, aged 70 rears and older, hospitalized for acute medical illness were enrolled in this multicenter, prospective cohort study. Functional mea surements obtained at discharge (Activities of Daily Living) and at 3 months after discharge (Activities of Daily Living and Instrumental Ac tivities of Daily Living) were compared with a preadmission baseline l evel of functioning to document loss and recovery of functioning.Resul ts: At discharge, 59% of the study population reported no-change, 10% improved, and 31% declined in Activities of Daily Living when compared with the preadmission baseline. At the 3-month follow-up, 51% of the original study population, for whom postdischarge data were available (n=1206),were found to have died (11%) or to report new Activities of Daily Living and/or Instrumental Activities of Daily Living disabiliti es (40%) when compared with the preadmission baseline. Among survivors , 19% reported a new Activities of Daily Living and 40% reported a new Instrumental Activities of Daily Living disability at follow-up. The 3-month outcomes were the result of the loss of function during the in dex hospitalization, the failure of many patients to recover after dis charge, and the development of new postdischarge disabilities. Patient s at greatest risk of adverse functional outcomes at follow-up were ol der, had preadmission Instrumental Activities of Daily Living disabili ties and lower mental status scores on admission, and had been rehospi talized. Conclusions: This study documents a high incidence of functio nal decline after hospitalization for acute medical illness. Although there are several potential explanations for these findings, this stud y suggests a need to reexamine current inpatient and postdischarge pra ctices that might influence the functioning of older patients.