Functional Outcomes of Acute Medical Illness and Hospitalization in Older Persons
Open accessAbstract
BACKGROUND: Short-stay hospitalization in older patients is frequently associated with a loss of function, which can lead to a need for postdischarge assistance and longer-term institutionalization. Because little is known about this adverse outcome of hospitalization, this study was conducted to (1) determine the discharge and 3-month postdischarge functional outcomes for a large cohort of older persons hospitalized for medical illness, (2) determine the extent to which patients were able to recover to preadmission levels of functioning after hospital discharge, and (3) identify the patient factors associated with an increased risk of developing disability associated with acute illness and hospitalization. METHODS: A total of 1279 community-dwelling patients, aged 70 years and older, hospitalized for acute medical illness were enrolled in this multicenter, prospective cohort study. Functional measurements obtained at discharge (Activities of Daily Living) and at 3 months after discharge (Activities of Daily Living and Instrumental Activities of Daily Living) were compared with a preadmission baseline level of functioning to document loss and recovery of functioning. RESULTS: At discharge, 59% of the study population reported no change, 10% improved, and 31% declined in Activities of Daily Living when compared with the preadmission baseline. At the 3-month follow-up, 51% of the original study population, for whom postdischarge data were available (n=1206), were found to have died (11%) or to report new Activities of Daily Living and/or Instrumental Activities of Daily Living disabilities (40%) when compared with the preadmission baseline. Among survivors, 19% reported a new Activities of Daily Living and 40% reported a new Instrumental Activities of Daily Living disability at follow-up. The 3-month outcomes were the result of the loss of function during the index hospitalization, the failure of many patients to recover after discharge, and the development of new postdischarge disabilities. Patients at greatest risk of adverse functional outcomes at follow-up were older, had preadmission Instrumental Activities of Daily Living disabilities and lower mental status scores on admission, and had been rehospitalized. CONCLUSION: This study documents a high incidence of functional decline after hospitalization for acute medial illness. Although there are several potential explanations for these findings, this study suggests a need to reexamine current inpatient and postdischarge practices that might influence the functioning of older patients.
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Ten days of bed rest in older adults was associated with a reduction in stair-climbing power (-14±4.1% in 10 days), a key measure of functional capacity.
“This was consistent with a reduction in stair-climbing power (-14±4.1% in 10 days), a key measure of functional capacity [22].”
From Protecting muscle mass and function in older adults during bed rest (2010) · cites this paper as [22]
Older adults are at increased risk of a poor outcome due to physical inactivity.
“In terms of predicting the likelihood of a poor outcome due to physical inactivity, it appears clear that older adults are at increased risk [4,7,23].”
From Protecting muscle mass and function in older adults during bed rest (2010) · cites this paper as [23]
Some performance measures (e.g., 5-min walk, 50-ft walk, 5-step test, functional reach, and floor transfer) may not be sensitive enough to detect change in a small cohort following short periods of bed rest.
“Although some performance measures (e.g., 5-min walk, 50-ft walk, 5-step test, functional reach, and floor transfer), may not be sensitive enough to detect change in a small cohort of study volunteers following short periods of bed rest [22], studies in bed-ridden hospitalized elders have demonstrated a clear negative relationship [4,23,24].”
From Protecting muscle mass and function in older adults during bed rest (2010) · cites this paper as [22]
Studies in bed-ridden hospitalized elders have demonstrated a clear negative relationship between bed rest and functional capacity.
“Although some performance measures (e.g., 5-min walk, 50-ft walk, 5-step test, functional reach, and floor transfer), may not be sensitive enough to detect change in a small cohort of study volunteers following short periods of bed rest [22], studies in bed-ridden hospitalized elders have demonstrated a clear negative relationship [4,23,24].”
From Protecting muscle mass and function in older adults during bed rest (2010) · cites this paper as [23]
In older adults, 10 days of bed rest resulted in a loss of knee extensor peak torque and 1-repetition maximum corresponding to a decrement of approximately 11-12% per week.
“In older adults, 10 days of bed rest resulted in a loss of knee extensor peak torque and 1-repetition maximum (1-RM) that corresponded to a decrement of approximately 11-12% per week [13,22].”
From Protecting muscle mass and function in older adults during bed rest (2010) · cites this paper as [22]
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References 27 · Cited by 578
- Authors
- Sager, M. A.
- Affiliations
- University of Wisconsin–Madison (US)
- Corresponding author
- Sager, Mark A.
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 1996-03-25
- Volume
- 156
- Issue
- 6
- Pages
- 645
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W2068994580
- Cited by
- 578
- References
- 27
- Citations by year
- 2026: 7 · 2025: 7 · 2024: 13 · 2023: 21 · 2022: 22 · 2021: 25 · 2020: 21 · 2019: 26 · 2018: 22 · 2017: 25 · 2016: 30 · 2015: 29 · 2014: 24 · 2013: 31 · 2012: 33
- FWCI
- 7.58
- Type
- journal article
- Language
- en
- Open access
- green
- nrs.harvard.edu
- Licence
- cc-by
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Keywords
- functional decline, hospitalization, older adults, acute conditions, activities of daily living, instrumental activities of daily living, hospital readmission, cognitive impairment, community-dwelling older adults
- MeSH terms
- Activities of Daily Living, Acute Disease, Aged, Aged, 80 and over, Female, Hospitalization, Humans, Male, Motor Activity, Prospective Studies, Logistic Models
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