IDENTIFYING HOSPITALIZED OLDER PATIENTS AT VARYING RISK FOR PHYSICAL PERFORMANCE DECLINE - A NEW APPROACH

OBJECTIVE: A classification tree analysis identifies patient groups at varying risk for decline in physical performance 1 year after hospita lization. DESIGN: Prospective cohort study. SETTING: Tertiary care VAM C. PARTICIPANTS: A total of 507 acutely ill hospitalized male veterans aged 65 years and older. MEASUREMENTS: Eighteen admission characteris tics were considered as potential predictors: demographic data, medica l diagnoses, functional status (e.g., ADL and IADL), geriatric conditi ons (e.g., incontinence, vision impairment, weight change), mental sta tus, depression, and physical functioning (measured by self-report (MO S-PFR) and the Physical Performance and Mobility Examination (PPME)). Outcome measure was change in PPME status at 12-months postadmission. RESULTS: Patients with the greatest risk for decline had both high bas eline physical performance (PPME greater than or equal to 9) and at le ast moderate self-report limitations on physical functioning (MOS-PFR less than or equal to 36, mean = 30.8). Patients with the lowest risk of decline had impaired baseline physical performance (PPME less than or equal to 8) but fewer self-report limitations on physical functioni ng (MOS-PFR greater than or equal to 31, mean = 37.4) and two or less geriatric conditions. CONCLUSIONS: The predictive role of self-report functioning suggests that perception of the impact of health on one's own physical functioning is associated with future performance. The nu mber of geriatric conditions is also an important predictor of physica l performance change. By identifying patient risk groups based on geri atric conditions, physical performance, and self-report physical funct ioning, future targeting strategies may improve physical performance o utcomes for hospitalized older adults.