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Cited by 487Frailty in Older AdultsAging, Health, and DisabilityIntensive Care Unit Cognitive Disorders

The Natural History of Functional Morbidity in Hospitalized Older Patients

Hirsch, Calvin H., Sommers, Lucia, Olsen, Anna, Mullen, Lisa, Winograd, Carol Hutner·1990·Journal of the American Geriatrics Society
DOI 10.1111/j.1532-5415.1990.tb03451.x
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Abstract

This study provides data on changes in the functional status of older patients that are associated with acute hospitalization. Seventy‐one patients over the age of 74 admitted to the medical service of Stanford University Hospital between February and May 1987 received functional assessments covering seven domains: mobility, transfer, toileting, incontinence, feeding, grooming, and mental status. Assessments were obtained by report from the patient's caregiver (or the patient when he or she lived alone) for 2 weeks before admission; from the patient's nurse on day 2 of hospitalization and on the day before discharge; and again from the caregiver (or patient) 1 week after discharge. The sample had a mean age of 84, covered 37 Diagnostic Related Groups, and had a median length of stay of 8 days. Between baseline and day 2, statistically significant deteriorations occurred for the overall functional score and for the individual scores for mobility, transfer, toileting, feeding, and grooming. None of these scores improved significantly by discharge. In the case of mobility, 65% of the patients experienced a decline in score between baseline and day 2. Between day 2 and discharge, 67°/o showed no improvement, and another 10% deteriorated further. These data suggest that older patients may experience a burden of new and worsened functional impairment during hospitalization that improves at a much slower rate than the acute illness. An awareness of delayed functional recovery should influence discharge planning for older patients. Greater efforts to prevent functional decline in the hospitalized older patient may be warranted.

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  • With advancing age, even a brief clinically mandated period of bed rest could initiate a serious decline in muscle strength and functional capacity, a tipping point from which some may not fully recover.

    “Thus, with advancing age, it becomes increasingly likely that even a brief, clinically mandated period of bed rest could initiate a serious decline in muscle strength and functional capacity, i.e., a “tipping point” from which some may not fully recover [4,7,8].”

    From Protecting muscle mass and function in older adults during bed rest (2010) · cites this paper as [7]

  • 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 [7]

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Authors
Hirsch, C. H., Sommers, L., Olsen, A., Mullen, L., & Winograd, C. H.
Affiliations
  • University of California, Davis (US)
  • Stanford University (US)
  • VA Palo Alto Health Care System (US)
  • Stanford Medicine (US)
Corresponding author
Hirsch, Calvin H.
ORCID
Hirsch, Calvin H.
Venue
Journal of the American Geriatrics Society
Publisher
Wiley
Published
1990-12
Volume
38
Issue
12
Pages
1296-1303
ISSN
  • 0002-8614 (ISSN-L)
  • 1532-5415
DOI
10.1111/j.1532-5415.1990.tb03451.x
OpenAlex
W2030598120
Cited by
485
References
15
Citations by year
2026: 5 · 2025: 7 · 2024: 13 · 2023: 18 · 2022: 10 · 2021: 18 · 2020: 15 · 2019: 19 · 2018: 16 · 2017: 18 · 2016: 18 · 2015: 18 · 2014: 23 · 2013: 27 · 2012: 17
FWCI
8.26
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 8913 d)
Locations
  • Journal of the American Geriatrics Society (publishedVersion)
  • PubMed (publishedVersion)
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, hospitalized older adults, functional status, mobility (physical function), toileting, incontinence, feeding, grooming, transfer, mental status, functional recovery, discharge planning, functional assessment, nursing home admission
MeSH terms
Activities of Daily Living, Aged, Aged, 80 and over, Diagnosis-Related Groups, Female, Hospitalization, Humans, Male, Prospective Studies, Geriatric Assessment

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