Functional deterioration in the month before hospitalisation is associated with in-hospital functional decline: an observational study
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Functional deterioration preceding acute hospital admission may be associated with poorer in-hospital outcomes. We sought to investigate the association between functional decline in the month preceding admission and in-hospital outcomes.
Materials and methods
Consecutive patients admitted under geriatric medicine over 5 years were prospectively included. Pre-hospital decline was defined as decrease in Modified Barthel Index (MBI) between pre-morbid status (1 month prior) and admission. The primary outcome was in-hospital functional decline (decline in MBI and/or new assistance/aid to mobilise). Secondary outcomes included length-of-stay (LOS; highest quartile), in-hospital falls and death.
Amongst 1458 patients (mean age 82.0; 60.91% female), 76.89% (1121/1458) experienced pre-hospital MBI decline. On univariate logistic regression, pre-hospital MBI decline was associated with in-hospital functional decline (OR 15.83, p < 0.001). Adjusting for age, nursing home residence, pre-morbid MBI, in-hospital referral source, dementia, adverse drug reaction and number of active diagnoses, pre-hospital decline was independently associated with in-hospital functional decline (OR 15.22, CI 10.89–21.26, p < 0.001). On univariate analysis, those with pre-hospital decline had more in-hospital falls (OR 2. 91, p = 0.02). Adjusting for age, sex, dementia, number of active diagnoses, and ambulation, no strong association was observed between pre-hospital decline and in-hospital falls (OR 1.86, p = 0.08). Prolonged LOS ≥ 20 days was more common amongst patients with pre-hospital decline on univariate (OR 1.95, p < 0.001) but not adjusted analyses (p = 0.14). No association was observed with in-hospital death.
Pre-hospital functional decline was associated with poorer in-hospital functional outcomes. Exploration of early interventions to optimise function in such patients is needed.
KeywordsFunction Frail elderly Hospitalisation Activities of daily living Patient outcome assessment
DNíC contributed to statistical analysis, drafting, revision and finalisation of the manuscript. DB contributed to study conceptualisation and design, patient recruitment, data collection, statistical analysis, drafting, revision and finalisation of the manuscript. DC and CS contributed to study conceptualisation and design, patient recruitment, data collection, and critical revision of the manuscript. All authors meet the criteria for authorship stated in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals. All authors are in agreement with the content of the manuscript.
Compliance with ethical standards
Conflict of interest
The abstract of this study was previously published in the Australasian Journal of Ageing (2016). This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
The institutional human ethics review committee of the area approved the study and all procedures performed in studies involving human participants were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
For this type of study formal consent is not required.
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