The journal of nutrition, health & aging

, Volume 15, Issue 8, pp 645–660 | Cite as

Reducing “iatrogenic disability” in the hospitalized frail elderly

  • C. Lafont
  • S. Gérard
  • T. Voisin
  • M. Pahor
  • B. Vellas
  • The members of I.A.G.G. / A.M.P.A Task Force
JNHA: Geriatric Science



Hospitalization is the first cause of functional decline in the elderly: 30 to 60% of elderly patients lose some independence in basic activities of daily living (ADL) during a stay in hospital. This loss of independence results from the acute condition that led to admission, but is also related to the mode of management.


This paper is a review of the literature on functional decline in elderly hospitalized patients. It is the first stage in a project aiming to prevent dependence that is induced during the course of care.


During a 2-day workshop in Monaco, a task force of 20 international experts discussed and defined the concept of “iatrogenic disability”.


1-“Iatrogenic disability” was defined by the task force as the avoidable dependence which often occurs during the course of care. It involves three components that interact and have a cumulative effect: a) the patient’s pre-existing frailty, b) the severity of the disorder that led to the patient’s admission, and lastly c) the hospital structure and the process of care. 2- The prevention of “iatrogenic disability” involves successive stages. - becoming aware that hospitalization may induce dependence. Epidemiological studies have identified at-risk populations by the use of composite scores (HARP, ISAR, SHERPA, COMPRI, etc). — considering that functional decline is not a fatality. Quality references have already been defined. Interventions to prevent dependence in targeted populations have been set up: simple geriatric consultation teams, single-factor interventions (aimed for example at mobility, delirium, iatrogenic disorders) or multidomain interventions (such as GEM and ACE units, HELP, Fast Track, NICHE). These interventions are essentially centered on the patient’s frailty and have limited results, as they take little account of the way the institution functions, which is not aimed at prevention of functional decline. The process of care reveals shortcomings: lack of geriatric knowledge, inadequate evaluation and management of functional status. The group suggests that interventions must not only identify at-risk patients so that they may benefit from specialized management, but they must also target the hospital structure and the process of care. This requires a graded “quality approach” and rethinking of the organization of the hospital around the elderly person.

Key words

Aged hospitalization iatrogenic disability functional decline geriatric assessment 


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  1. 1.
    Sager, M.A. and M.A. Rudberg, Functional decline associated with hospitalization for acute illness. Clin Geriatr Med, 1998. 14(4): p. 669–679.PubMedGoogle Scholar
  2. 2.
    Kleinpell, R.M., K. Fletcher, and B.M. Jennings, Reducing Functional Decline in Hospitalized Elderly, in Patient Safety and Quality: An Evidence Based Hand-Book for Nurses. 2008, Agency for Health Care Research and Quality (US): Rockville (MD).Google Scholar
  3. 3.
    Sager, M.A., et al., Functional outcomes of acute medical illness and hospitalization in older persons. Arch Intern Med 1996. 156(6): p.645–652.PubMedCrossRefGoogle Scholar
  4. 4.
    Chang, H.H., et al., Outcomes of hospitalized elderly patients with geriatric syndrome: report of a community hospital reform plan in Taiwan. Arch Gerontol Geriatr, 2010. 50Suppl 1: p. S30–S33.PubMedCrossRefGoogle Scholar
  5. 5.
    McCusker, J, R. Kakuma, and M. Abrahamowicz, Predictors of functional decline in hospitalized elderly patients: a systematic review. J Gerontol A Biol Sci Med Sci, 2002. 57(9): p. M569–M577.PubMedCrossRefGoogle Scholar
  6. 6.
    Réduire l’Incidence des Accidents Médicamenteux et Non Médicamenteux, in Conférence Nationale de Santé. 1996: Paris.Google Scholar
  7. 7.
    Garros, B. Contribution du HCSP aux réflexions sur la lutte contre l’iarogénie, in Conférence Nationale de Santé 1998. Paris.Google Scholar
  8. 8.
    Sutton, M., K. Grimmer-Somers, and L. Jeffries, Screening tools to identify hospitalised elderly patients at risk of functional decline: a systematic review. Int J Clin Pract, 2008. 62(12): p. 1900–1909.PubMedCrossRefGoogle Scholar
  9. 9.
    Formiga, F., et al., Natural history of functional decline 1 year after hospital discharge in nonagenarian patients. J Am Geriatr Soc, 2003. 51(7): p. 1040–1041.PubMedCrossRefGoogle Scholar
  10. 10.
    McCusker, J, et al., Delirium in older medical inpatients and subsequent cognitive and functional status: a prospective study. Cmaj, 2001. 165(5): p. 575–583.PubMedGoogle Scholar
  11. 11.
    Campbell, S.E., et al., A multi-centre European study of factors affecting the discharge destination of older people admitted to hospital: analysis of in-hospital data from the ACMEplus project. Age Ageing, 2005. 34(5): p. 467–475.PubMedCrossRefGoogle Scholar
  12. 12.
    Salvi, F., et al., Mini Nutritional Assessment (short form) and functional decline in older patients admitted to an acute medical ward. Aging Clin Exp Res, 2008. 20(4): p. 322–328.PubMedGoogle Scholar
  13. 13.
    Sleiman, I., et al., Functional trajectories during hospitalization: a prognostic sign for elderly patients. J Gerontol A Biol Sci Med Sci, 2009. 64(6): p. 659–663.PubMedCrossRefGoogle Scholar
  14. 14.
    Carlson, J.E., et al., Measuring frailty in the hospitalized elderly: concept of functional homeostis. Am J Phys Med Rehabil, 1998. 77(3): p. 252–257.PubMedCrossRefGoogle Scholar
  15. 15.
    Boyd, C.M., et al., Hospitalization and development of dependence in activities of daily living in a cohort of disabled older women the Women’s Health and Aging Study I. J Gerontol A Biol Sci Med Sci, 2005. 60(7): p. 888–893.PubMedCrossRefGoogle Scholar
  16. 16.
    Boyd, C.M., et al., Functional decline and recovery of activities of daily living in hospitalized, disabled older women the Women’s Health and Aging Study I. J Am Geriatr Soc, 2009. 57(10): p. 1757–1766.PubMedCrossRefGoogle Scholar
  17. 17.
    McVey, L.J, et al., Effect of a geriatric consultation team on functional status of elderly hospitalized patients. A randomized controlled clinical trial. Ann Intern Med, 1989. 110(1): p. 79–84.PubMedGoogle Scholar
  18. 18.
    Hirsch, C.H., et al., The natural history of functional morbidity in hospitalized older patients. J Am Geriatr Soc, 1990. 38(12): p. 1296–1303.PubMedGoogle Scholar
  19. 19.
    Maigitic, S.E, et al., Hospital Outcomes Project for the Elderly (HOPE): rationale and design for a prospective pooled analysis. J Am Geriatr Soc, 1993. 41(3): p. 258–267.Google Scholar
  20. 20.
    Arora, V.M., et al., Relaionship between quality of care and functional decline in hospitalized vulnerable elders. Med Care, 2009. 47(8): p. 895–901.PubMedCrossRefGoogle Scholar
  21. 21.
    Volpato, S., et al., Predictive value of the Short Physical Performance Battery following hospitalization in older patients. J Gerontol A Biol Sci Med Sci, 2011. 66(1): p. 89–96.PubMedCrossRefGoogle Scholar
  22. 22.
    Wu, A.W., et al., Predicting functional status outcomes in hospitalized patients aged 80 years and older. J Am Geriatr Soc, 2000. 48(5 Suppl): p. S6–S15.PubMedGoogle Scholar
  23. 23.
    Wu, H.Y., S. Sahadevan, and Y.Y. Ding, Factors associated with functional decline of hospitalised older persons following discharge from an acute geriatric unit. Ann Acad Med Singapore, 2006. 35(1): p. 17–23.PubMedGoogle Scholar
  24. 24.
    de Saint-Hubert, M., et al., Comparison of three tools predicting functional decline after hospitalizaion of older patients. J Am Geriatr Soc, 2010. 58(5): p. 1003–1005.PubMedCrossRefGoogle Scholar
  25. 25.
    King, B.D., Functional decline in hospitalized elders. Medsurg Nurs, 2006. 15(5): p. 265–271; quiz 272.PubMedGoogle Scholar
  26. 26.
    de Saint-Hubert, M., et al., Risk factors predicting later functional decline in older hospitalized patients. Acta Clin Belg, 2009. 64(3): p. 187–194.PubMedGoogle Scholar
  27. 27.
    Fried, L.P., et al., Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci, 2001. 56(3): p. M146–M156.PubMedCrossRefGoogle Scholar
  28. 28.
    Zureik, M., et al., Predicting the outcome in elderly patients of hospital admission for acute care in Paris, France: construction and initial validation of a simplex index. J Epidemiol Community Health, 1997. 51(2): p. 192–198.PubMedCrossRefGoogle Scholar
  29. 29.
    Mahoney, J.E., M.A. Sager, and M. Jalaluddin, New walking dependence associated with hospitalization for acute medical illness: incidence and significance. J Gerontol A Biol Sci Med Sci, 1998. 53(4): p. M307–M312.PubMedCrossRefGoogle Scholar
  30. 30.
    Volpato, S., et al., Characteristics of nondisabled older patients developing new disability associated with medical illnesses and hospitalization. J Gen Intern Med, 2007. 22(5): p. 668–674.PubMedCrossRefGoogle Scholar
  31. 31.
    Sager, M.A., et al., Hospital admission risk profile (HARP): identifying older patients a risk for functional decline following acute medical illness and hospitalization. J Am Geriatr Soc, 1996. 44(3): p. 251–257.PubMedGoogle Scholar
  32. 32.
    Anpalahan, M. and S.J. Gibson, Geriatric syndromes as predictors of adverse outcomes of hospitalization. Intern Med J, 2008. 38(1): p. 16–23.PubMedGoogle Scholar
  33. 33.
    Covinsky, K.E., et al., Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc, 2003. 51(4): p. 451–458.PubMedCrossRefGoogle Scholar
  34. 34.
    Inoie, S.K., et al., A predictive index for functional decline in hospitalized elderly medical patients. J Gen Intern Med, 1993. 8(12): p. 645–652.CrossRefGoogle Scholar
  35. 35.
    Pedone, C, et al., Elderly patients with cognitive impairment have a high risk for functional decline during hospitalization: The GIFA Study. J Gerontol A Biol Sci Med Sci, 2005. 60(12): p. 1576–1580.PubMedCrossRefGoogle Scholar
  36. 36.
    Sands, L.P., et al., The effects of acute illness on ADL decline over 1 year in frail older adults with and without cognitive impairment. J Gerontol A Biol Sci Med Sci, 2002. 57(7): p. M449–M454.PubMedCrossRefGoogle Scholar
  37. 37.
    Inouye, S.K., et al., Does delirium contribute to poor hospital outcomes? A three-site epidemiologic study. J Gen Intern Med, 1998. 13(4): p. 234–242.PubMedCrossRefGoogle Scholar
  38. 38.
    Cornette, P., et al., Early evaluation of the risk of functional decline following hospitalization of older patients: development of a predictive tool. Eur J Public Health, 2006. 16(2): p. 203–208.PubMedCrossRefGoogle Scholar
  39. 39.
    Givens, J.L., R.N. Jones, and S.K. Inouye, The overlap syndrome of depression and delirium in older hospitalized patients. J Am Geriatr Soc, 2009. 57(8): p. 1347–1353.PubMedCrossRefGoogle Scholar
  40. 40.
    Mateev, A., et al., Use of a short-form screening procedure to detect unrecognized functional disability in the hospitalized elderly. J Clin Epidemiol, 1998. 51(4): p. 309–314.PubMedCrossRefGoogle Scholar
  41. 41.
    Lang, P.O., et al., Loss of independence in Katz’s ADL ability in connection with an acute hospitalization: early clinical markers in French older people. Eur J Epidemiol, 2007.22(9): p. 621–630.PubMedCrossRefGoogle Scholar
  42. 42.
    McCusker, J., et al., Detection of older people at increased risk of adverse health outcomes after an emergency visit: the ISAR screening tool. J Am Geriatr Soc, 1999. 47(10): p. 1229–1237.PubMedGoogle Scholar
  43. 43.
    Wakefield, B.J. and J.E. Holman, Functional trajectories associated with hospitalization in older adults. West J Nurs Res, 2007. 29(2): p. 161–177; discussion 178–82.PubMedCrossRefGoogle Scholar
  44. 44.
    Li, A.K., et al., Reports of financial disability predict functional decline and death in older patients discharged from the hospital. J Gen Intern Med, 2005. 20(2): p. 168–174.PubMedCrossRefGoogle Scholar
  45. 45.
    Graf C, Functional decline in hospitalized older adults. Am J Nurs, 2006. 106(1): p. 58–67, quiz 67–8.PubMedCrossRefGoogle Scholar
  46. 46.
    Winograd, C.H., et al., Screening for frality: criteria and predictors of outcomes. J Am Geriatr Soc, 1991. 39(8): p. 778–784.PubMedGoogle Scholar
  47. 47.
    Onder, G., et al., Impact of inappropriate drug use among hospitalized older adults. Eur J Clin Pharmacol,2005. 61(5–6): p. 453–459.PubMedCrossRefGoogle Scholar
  48. 48.
    Mahoney, J.E, M.A. Sager, and M. Jalaluddin, Use of an ambulation assistive device predicts functional decline associated with hospitalization. J Gerontol A Biol Sci Med Sci, 1999.54(2): p. M83–M88.PubMedCrossRefGoogle Scholar
  49. 49.
    Lindenberger, E.C., et al., Unsteadiness reported by older hospitalized patients predicts functional decline. J Am Geriatr Soc, 2003. 51(5): p. 621–626.PubMedCrossRefGoogle Scholar
  50. 50.
    Covinsky, K.E., et al., The relationship between clinical assessments of nutritional status and adverse outcomes in older hospitalized medical patients. J Am Geriatr Soc, 1999. 47(5): p. 532–538.PubMedGoogle Scholar
  51. 51.
    Inouye, S.K., et al., The Hospital Elder Life Program: a model of care to prevent cognitive and functional decline in older hospitalized patients. Hospital Elder Life Program. J Am Geriatr Soc, 2000. 48(12): p. 1697–1706.PubMedGoogle Scholar
  52. 52.
    Inoie, S.K., et al., Geriatric syndromes: clinical, research and policy implications of a core geriatric concept. J Am Geriatr Soc, 2007. 55(5): p. 780–791.CrossRefGoogle Scholar
  53. 53.
    Hoogerduijn, J.G., et al., A systematic review of predictors and screening instruments to identify older hospitalized patients at risk for functional decline. J Clin Nurs, 2007. 16(1): p. 46–57.PubMedCrossRefGoogle Scholar
  54. 54.
    Swine Ch, D.J., Schoevaerdts D, Boland B, Cornette P, L’évaluation de la personne âgée et le système RAI-MDS. Louvain Médical, 2006. 125(9): p. S337–S343.Google Scholar
  55. 55.
    Hustey, F.M., et al., A brief risk stratification tool to predict functional decline in older adults discharged from emergency departments. J Am Geriatr Soc, 2007. 55(8): p. 1269–1274.CrossRefGoogle Scholar
  56. 56.
    Guralnik, J.M., et al., A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol, 1994. 49(2): p. M85–M94.PubMedGoogle Scholar
  57. 57.
    Huyse, F.J., et al., COMPRI—an instrument to detect patients with complex care needs: results from a European study. Psychosomatics, 2001. 42(3): p. 222–228.PubMedCrossRefGoogle Scholar
  58. 58.
    De Saint-Hubert, M., et al., Predicting functional adverse outcomes in hospitalized older patients: a systematic review of screening tools. J Nutr Health Aging, 2010. 14(5): p. 394–399.PubMedCrossRefGoogle Scholar
  59. 59.
    Hoogerduijn, J.G., et al., Identification of older hospitalised patients at risk for functional decline, a study to compare the predictive values of three screening instruments. J Clin Nurs, 2010. 19(9–10): p. 1219–1225.PubMedCrossRefGoogle Scholar
  60. 60.
    Braes, T, et al., Predicting the risk of functional decline in older patients admitted to the hospital: a comparison of three screening instruments. Age Ageing, 2009. 38(5): p. 600–603.PubMedCrossRefGoogle Scholar
  61. 61.
    Salvi, F, et al., Predictive validity of the Identification of Seniors At Risk (ISAR) screening tool in elderly patients presenting to two Italian Emergency Departments. Aging Clin Exp Res, 2009. 21(1): p. 69–75.PubMedGoogle Scholar
  62. 62.
    Rubensteia L.Z., et al., Effectiveness of a geriatric evaluation unit. A randomized clinical trial. N Engl J Med 1984. 311(26): p. 1664–1670.CrossRefGoogle Scholar
  63. 63.
    Stuck, A.E., et al., Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet, 1993. 342(8878): p. 1032–1036.PubMedCrossRefGoogle Scholar
  64. 64.
    Calkins E, N.B., Care of older people in the hospital., in New ways to care for older people. Building systems based on evidence, B.C. Calkins E, Wagner EH, Pacala JT, Edrtor. 1998, Springer: New York. p. 99–111.Google Scholar
  65. 65.
    Ellis, G. and P. Langhorne, Comprehensive geriatric assessment for older hospital patients. Br Med Bull, 2004. 71: p. 45–59.PubMedCrossRefGoogle Scholar
  66. 66.
    Parker, S.G., R. Fadayevatan, and S.D. Lee, Acute hospital care for frail older people. Age Ageing, 2006. 35(6): p. 551–552.PubMedCrossRefGoogle Scholar
  67. 67.
    Palmer RM, C.S., Landefeld SC, Acute care for elders units. Practical considerations for optimizing health outcomes. Dis manage health outcomes, 2003(11): p. 507–517.Google Scholar
  68. 68.
    Gray, L., Geriatric consultation: is there a future? Age Ageing, 2007. 36(1): p. 1–2.PubMedCrossRefGoogle Scholar
  69. 69.
    Siebens, H., et al., A randomized controlled trial of exercise to improve outcomes of acute hospitalization in older adults. J Am Geriatr Soc, 2000. 48(12): p. 1545–1552.PubMedGoogle Scholar
  70. 70.
    Malleiy, L.H., et al., The feasibility of performing resistance exercise with acutely ill hospitalized older adults. BMC Geriatr, 2003. 3: p. 3.CrossRefGoogle Scholar
  71. 71.
    de Morton, N.A., J.L. Keying, and K. Jeffs, Exercise for acutely hospitalised older medical patients. Cochrane Database Syst Rev, 2007(1): p. CD005955.Google Scholar
  72. 72.
    Vidan, M.T, et al., An intervention integrated into daily clinical practice reduces the incidence of delirium during hospitalization in elderly patients. J Am Geriatr Soc, 2009. 57(11): p. 2029–2036.PubMedCrossRefGoogle Scholar
  73. 73.
    Capezuti EA, Mezey MD, Geriatric Evaluation and Management Units, in The Encyclopedia of Elder Care: The Comprehensive Resource on Geriatric and Social Care. 2007, Springer: New York p. 355–358.Google Scholar
  74. 74.
    Landefeld, C.S., et al., A randomized trial of care in a hospital medical unit especially designed to improve the functional outcomes of acutely ill older patients. N Engl J Med, 1995.332(20): p. 133844.CrossRefGoogle Scholar
  75. 75.
    Covinski, K.E., et al., Do acute care for elders units increase hospital costs? A cost analysis using the hospital perspective. J Am Geriatr Soc, 1997. 45(6): p. 729–734.Google Scholar
  76. 76.
    Counsell, S.R., et al., Effects of a multicomponent intervention on functional outcomes and process of care in hospitalized older patients: a randomized controlled trial of Acute Care for Elders (ACE) in a community hospital. J Am Geriatr Soc, 2000. 48(12): p. 1572–1581.PubMedGoogle Scholar
  77. 77.
    Baztan, J.J., et al., Effectiveness of acute geriatric units on functional decline, living a home, and case fatality among older patients admitted to hospital for acute medical disorders: meta-analysis. Bmj, 2009. 338: p. b50.PubMedCrossRefGoogle Scholar
  78. 78.
    Inouye, S.K., et al., A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med, 1999.340(9): p. 669–676.PubMedCrossRefGoogle Scholar
  79. 79.
    Rizzo, J.A., et al., Multicomponent targeted intervention to prevent delirium in hospitalized older patients: what is the economic value? Med Care, 2001. 39(7): p. 740–752.PubMedCrossRefGoogle Scholar
  80. 80.
    Inouye, S.K., et al., The role of adherence on the effectiveness of nonpharmacologic interventions: evidence from the delirium prevention trial. Arch Intern Med, 2003. 163(8): p. 958–964.PubMedCrossRefGoogle Scholar
  81. 81.
    Kehlet, H. and J. Rosenberg, Late post-operative hypoxaemia and organ dysfunction. Eur J Anaesthesiol Suppl, 1995. 10: p. 314.Google Scholar
  82. 82.
    Bardram, L., et al., Recovery after laparoscopic colonic surgery with epidural analgesia, and early oral nutrition and mobilisation. Lancet, 1995. 345(8952): p. 763–764.PubMedCrossRefGoogle Scholar
  83. 83.
    Basse, L., et al., A clinical pathway to accelerate recovery after colonic resection. Ann Surg, 2000. 232(1): p. 51–57.PubMedCrossRefGoogle Scholar
  84. 84.
    Kehlet, H. and D.W. Wilmore, Multimodal strategies to improve surgical outcome. Am J Surg, 2002. 183(6): p. 63041.CrossRefGoogle Scholar
  85. 85.
    Fearon, K.C., et al., Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr, 2005. 24(3): p. 466–477.PubMedCrossRefGoogle Scholar
  86. 86.
    Muller, S., et al., A fast-track program reduces complications and length of hospital stay after open colonic surgery. Gastroenterology, 2009. 136(3): p. 842–847.PubMedCrossRefGoogle Scholar
  87. 87.
    Wind, I, et al., Systematic review of enhanced recovery programmes in colonic surgery. Br J Surg, 2006. 93(7): p. 800–809.PubMedCrossRefGoogle Scholar
  88. 88.
    Lassen, K., et al., Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg, 2009. 144(10): p. 961–969.PubMedCrossRefGoogle Scholar
  89. 89.
    Wilmore, D.W. and H. Kehlet, Management of patients in fast track surgery. Bmj, 2001.322(7284): p. 473–476.PubMedCrossRefGoogle Scholar
  90. 90.
    Swauger, K. and C. Tomlin, Best care for the elderly at Forsyth Medical Center. Geriatr Nurs, 2002. 23(3): p. 145–150.PubMedCrossRefGoogle Scholar
  91. 91.
    Mezey, M., et al., Nurses Improving Care to Health System Elders (NICHE): implementation of best practice models. J Nurs Adm, 2004. 34(10): p. 451–457.PubMedCrossRefGoogle Scholar
  92. 92.
    Mezey MD, F.T., Abraham I, Geriatric nursing protocols for best practice. 2nd ed. 2003, New York: Springer.Google Scholar
  93. 93.
    Palmer, R.M., Acute hospital care of the elderly: minimizing the risk of functional decline. Cleve Clin J Med 1995. 62(2): p. 117–128.PubMedGoogle Scholar
  94. 94.
    Rozzini, R., et al., Relationship between functional loss before hospital admission and mortality in elderly persons with medical illness. J Gerontol A Biol Sci Med Sci, 2005.60(9): p. 1180–1183.PubMedCrossRefGoogle Scholar
  95. 95.
    Ferrucci, L., et al., Hospital diagnoses. Medicare charges, and nursing home admissions in the year when older persons become severely disabled. Jama, 1997. 277(9): p. 728–734.PubMedCrossRefGoogle Scholar
  96. 96.
    Koenig, H.G., et al., Hospital stressors experienced by elderly medical inpatients: developing a Hospital Stress Index. Int J Psychiatry Med, 1995.25(1): p. 103–122.PubMedCrossRefGoogle Scholar
  97. 97.
    Gillis, A. and B. MacDonald, De conditioning in the hospitalized elderly. Can Nurse, 2005. 101(6): p. 16–20.PubMedGoogle Scholar
  98. 98.
    Gray, S.L., et al., Adverse drug events in hospitalized elderly. J Gerontol A Biol Sci Med Sci, 1998. 53(1): p. M59–M63.PubMedCrossRefGoogle Scholar
  99. 99.
    Holroyd-Leduc, J.M., et al., The relationship of indwelling urinary catheters to death, length of hospital stay, functional decline, and nursing home admission in hospitalized older medical patients. J Am Geriatr Soc, 2007. 55(2): p. 227–233.PubMedCrossRefGoogle Scholar
  100. 100.
    Palmer, R.M., S. Counsell, and C.S. Landefeld, Clinical intervention trials: the ACE unit. Clin Geriar Med, 1998. 14(4): p. 83149.Google Scholar
  101. 101.
    Lafrenière S, Dupras A, Expérience d’amélioration de la qualité des soins aigus de la clientèle agée. Un défi clinique et de gestion. In Ordre des infirmières et des infirmiers du Quebec. 2009. Montreal.Google Scholar
  102. 102.
    Dupras A, Lafrenière. S, Présentation sur le projet OPTIMAH (projet d’optimisation des soins aux malades âgés hospitalisés). 2007. CHUM. Montréal.Google Scholar
  103. 103.
    Wenger, N.S., C.P. Roth, and P. Shekelle, Introduction to the assessing care of vulnerable eldeis-3 quality indicator measurement set. J Am Geriatr Soc, 2007. 55Suppl 2: p. S247–S252.PubMedCrossRefGoogle Scholar
  104. 104.
    Carr M, P.H., Report and Recommandations: Acute care geriatric nurse network., T.N.D.M.o.H. Planning, Editor. 2003, CNS Collaborative.Google Scholar
  105. 105.
    AHMAC, Best practice approaches to minimise functional decline in the older person across the acute, sub-acute and residential care settings, V.G.D.o.H. Services, Editor. 2007, Victorian Government Department of Human Services,. p. 29.106. Care Quality Commission, Essential standards of quality and safety, S.C National Health Service, Public Health, England, Editor. 2010, Parliament of United Kingdom.Google Scholar
  106. 106.
    Care Quality Commission, Essential standards of quality and safety. In National Health Service SC, Public Health, England, ed.: Parliament of United Kingdom; 2010.Google Scholar
  107. 107.
    Dramé M, Fierobe F, Lang PO, Jolly D, Boyer F, Mahmoudi R, Somme D, Laniece I, Heitz D, Gauvain JB, Voisin T, De Wazieres B, Gonthier R, Ankri J, Saint-Jean O, Couturier P, Jeandel C, Blanchard F, Novella JL. Predictors of institution admission in the year following acute hospitalisation of elderly people. J Nutr Health Aging. 2011 May;15(5):399–403.PubMedCrossRefGoogle Scholar
  108. 108.
    Charlton KE, Nichols C, Bowden S, Lambert K, Barone L, Mason M, Milosavljevic M. Older rehabilitation patients are at high risk of malnutrition: evidence from a large Australian database. J Nutr Health Aging. 2010 Oct; 14(8):622–628.PubMedCrossRefGoogle Scholar
  109. 109.
    Somers A, Robs H, Vander Stichele R, Van Maele G, Bogaert M, Petrovic M. Contribution of drug relied problems to hospital admission in the elderly. J Nutr Health Aging 2010 Jun;14(6):477–482.PubMedCrossRefGoogle Scholar
  110. 110.
    De Saint-Hubert M, Schoevaerdts D, Cornette P, D’Hoore W, Boland B, Swine C. Predicting functional adverse outcomes in hospitalized older patients: a systematic review of screening tools. J Nutr Health Aging. 2010 May;14(5):394–399.PubMedCrossRefGoogle Scholar
  111. 111.
    Voisin T, Andrieu S, Cantet C, Vellas B; REAL.FR Group. Predictive factors of hospitalizations in Alzheimer disease: a two-year prospective study in 686 patients of the REAL.FR study. J Nutr Health Aging. 2010 Apr;14(4):288–291.PubMedCrossRefGoogle Scholar
  112. 112.
    Lang PO, Zekiy D, Michel JP, Drame M, Novella JL, Jolly D, Blanchard F. Early markers of prolonged hospital stay in demented inaptients: a multicentre and prospective study. J Nutr Health Aging. 2010 Feb;14(2):141–147.PubMedCrossRefGoogle Scholar

Copyright information

© Serdi and Springer Verlag France 2011

Authors and Affiliations

  • C. Lafont
    • 1
  • S. Gérard
    • 1
  • T. Voisin
    • 1
  • M. Pahor
    • 2
  • B. Vellas
    • 3
  • The members of I.A.G.G. / A.M.P.A Task Force
  1. 1.Gérontopôle, Department of Geriatric MedicineCHU ToulouseToulouseFrance
  2. 2.Department of Aging and Geriatric ResearchUniversity of Florida-Institute on AgingGainesvilleUSA
  3. 3.Department of Internal Medicine and Geriatrics, Chief of Alzheimer’s Disease Clinical Research CentreToulouse University HospitalToulouseFrance

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