Patient-related risk factors for in-hospital functional decline in older adults: a systematic review and meta-analysis
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Background: Functional decline (FD) is a common and serious problem among hospitalised older adults. Objective: This systematic review and meta-analysis aims to identify patient-related risk factors for in-hospital FD in older adults. Methods: Previous reviews on this topic (1970-2007) and the databases PubMed, Embase, and CINAHL (January 2007-December 2020) were searched. Reference lists of included articles were screened. Studies investigating patient-related risk factors for FD from (pre)admission to discharge in older adults admitted to an acute geriatric or internal medical unit were included. Study quality was assessed using the modified Newcastle-Ottawa Scale. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using random-effects models. The quality of evidence was assessed using GRADE. Results: Twenty-nine studies met the inclusion criteria. Statistically significant risk factors were living in a nursing home (OR, 2.42; 95% CI, 1.29-4.52), impairment in instrumental activities of daily living (OR, 2.08; 95% CI, 1.51-2.86), history of falls (OR, 1.71; 95% CI, 1.00-2.92), cognitive impairment (OR, 1.83; 95% CI, 1.56-2.14), dementia (OR, 1.71; 95% CI, 1.23-2.38), delirium (OR, 2.34; 95% CI, 1.88-2.93), (risk of) malnutrition (OR, 1.76; 95% CI, 1.03-3.03), hypoalbuminemia (OR, 1.79; 95% CI, 1.36-2.36), comorbidity (OR, 1.09; 95% CI, 1.03-1.16), and the presence of pressure ulcers (OR, 3.33; 95% CI, 1.82-6.09). The narrative synthesis suggested prehospital FD, needing assistance with walking, and low body mass index as additional risk factors. Conclusions: Several patient-related risk factors for in-hospital FD were identified that can be used at hospital admission to identify older patients at risk of FD.
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Cognitive impairment is a risk factor for delirium, which is a risk factor for further cognitive deterioration and functional decline.
“Cognitive impairment is a risk factor for delirium which is a risk factor for further cognitive deterioration and functional decline.(551)”
From Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission (2024) · cites this paper as [551]
The Mental status section reports that delirium at admission is associated with increased risk of in-hospital functional decline in older adults. It also finds cognitive impairment associated with functional decline, but does not establish that cognitive impairment increases delirium risk or that delirium leads to further cognitive deterioration. (LLM, conf=0.88)
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- Authors
- Geyskens, L., Jeuris, A., Deschodt, M., Van Grootven, B., Gielen, E., & Flamaing, J.
- Affiliations
- KU Leuven (BE)
- Jessa Hospital (BE)
- Universitair Ziekenhuis Leuven (BE)
- Department of Public Health and Primary Care, KU Leuven – University of Leuven, Leuven 3000, Belgium
- Corresponding author
- Deschodt, Mieke
- Venue
- Age and Ageing
- Publisher
- Oxford University Press (OUP)
- Published
- 2022-02
- Volume
- 51
- Issue
- 2
- ISSN
- 0002-0729 (ISSN-L)
- 1468-2834
- OpenAlex
- W4210921185
- Cited by
- 70
- References
- 64
- Citations by year
- 2026: 19 · 2025: 24 · 2024: 12 · 2023: 12 · 2022: 3
- FWCI
- 1.82
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Age and Ageing (publishedVersion)
- PubMed (publishedVersion)
- Lirias (KU Leuven) (submittedVersion)
- Lirias (submittedVersion, other-oa)
- Funders
- KU Leuven
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Keywords
- older adults, patient risk factors, nursing home residents, instrumental activities of daily living, fall history, cognitive impairment, dementia, delirium, malnutrition, hypoalbuminemia, comorbidities, pressure ulcers, body mass index, hospitalized older adults, medical inpatients
- MeSH terms
- Activities of Daily Living, Aged, Hospitalization, Hospitals, Humans, Risk Factors, Cognitive Dysfunction
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