Use of an ambulation assistive device predicts functional decline associated with hospitalization

Background Loss of functional independence occurs frequently with hospitali zation. In community-dwelling elders, lower extremity disability is an impo rtant predictor of functional loss. Ambulation assistive devices (canes, wa lkers), as markers of lower extremity disability, may predict functional de cline associated with hospitalization, but this has not been evaluated prev iously. We sought to determine the association of mobility impairment, as i ndicated by cane or walker use prehospitalization, with adverse outcomes at hospital discharge and 3 months post discharge. Methods. Subjects were community-dwelling adults (N = 1212) aged 70 and old er, hospitalized for acute medical illness. The study was a secondary analy sis of the Hospital Outcomes Project for the Elderly, a prospective randomi zed trial at three university and two private acute-care hospitals, which r andomized patients to usual care or an intervention group designed to maint ain functional abilities. Results. After controlling for demographic and illness-related characterist ics and prehospital function, mobility impairment was significantly associa ted with functional decline. Use of a walker was associated with 2.8 times increased risk for decline in ADL function by hospital discharge (p = .0002 ). Three months after discharge, patients who used assistive devices prior to hospitalization were more likely to have declined in both ADLs (p = .02) and IADLs (p = .003). Conclusions. Hospitalized patients with mobility impairment, as indicated b y use of a cane or a walker, are at high risk for functional decline. Such patients may benefit from more intensive in-hospital and post-hospital reha bilitative therapy to maintain function.