Hospitalization and subsequent disability risk in geriatric patients

January 01, 0001

Hospitalization and subsequent disability risk in geriatric patients

Disability in geriatric patients can be a challenging and complex process. These US researchers examined whether illnesses and injuries were linked to transitions among states of no disability, mild disability, severe disability, and death. They performed a prospective cohort study of community- dwelling non-disabled patients aged 70 or above(n=754). Enrollees were followed for more than 10 years via montly telephone interviews. Physical frailty was assessed every 18 months.

The researchers found: "Hospitalization was strongly associated with 8 of the 9 possible transitions, with increased multivariable hazard ratios (HRs) as high as 168 for the transition from no disability to severe disability and decreased HRs as low as 0.41 for the transition from mild disability to no disability. Restricted activity also increased the likelihood of transitioning from no disability to both mild and severe disability (HR, 2.59 and HR, 8.03), respectively, and from mild disability to severe disability (HR, 1.45), but was not associated with recovery from mild or severe disability. For all 9 transitions, the presence of physical frailty accentuated the associations of the intervening events. For example, the absolute risk of transitioning from no disability to mild disability within 1 month after hospitalization for frail individuals was 34.9% vs 4.9% for nonfrail individuals. Among the possible reasons for hospitalization, fall- related injury conferred the highest likelihood of developing new or worsening disability."

The researchers concluded: "Among older persons, particularly those who were physically frail, intervening illnesses and injuries greatly increased the likelihood of developing new or worsening disability. Only the most potent events, ie, those leading to hospitalization, reduced the likelihood of recovery from disability."

This study provides important quantification of risk of disability in geriatric patients following hospitalization.

For the full abstract, click here.

JAMA 304(17):1919-1928, 3 November 2010 © 2010 American Medical Association
Change in Disability After Hospitalization or Restricted Activity in Older Persons. Thomas M. Gill, Heather G. Allore, Evelyne A. Gahbauer, Terrence E. Murphy.

Category: A. General/Unspecified. Keywords: disability, hospitalization, falls, illness, injury, prospective cohort, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 23 November 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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