Functional changes during hospital stay in older patients admitted to an acute care ward : a multicenter observational study

Objectives: Changes in physical performance during hospital stay have rarely been evaluated. In this study, we examined functional changes during hospital stay by assessing both physical performance and activities of daily living. Additionally, we investigated characteristics of older patients associated with meaningful in-hospital improvement in physical performance. Methods: The CRiteria to assess appropriate Medication use among Elderly complex patients project recruited 1123 patients aged >= 65 years, consecutively admitted to geriatric or internal medicine acute care wards of seven Italian hospitals. We analyzed data from 639 participating participants with a Mini Mental State Examination score >= 18/30. Physical performance was assessed by walking speed and grip strength, and functional status by activities of daily living at hospital admission and at discharge. Meaningful improvement was defined as a measured change of at least 1 standard deviation. Multivariable logistic regression models predicting meaningful improvement, included age, gender, type of admission (through emergency room or elective), and physical performance at admission. Results: Mean age of the study participants was 79 years (range 65-98), 52% were female. Overall, mean walking speed and grip strength performance improved during hospital stay (walking speed improvement: 0.04 +/- 0.20 m/s, p<0.001; grip strength improvement: 0.43 +/- 5.66 kg, p = 0.001), no significant change was observed in activities of daily living. Patients with poor physical performance at admission had higher odds for in-hospital improvement. Conclusion: Overall, physical performance measurements show an improvement during hospital stay. The margin for meaningful functional improvement is larger in patients with poor physical function at admission. Nevertheless, most of these patients continue to have poor performance at discharge

A multicomponent approach to identify predictors of hospital outcomes in older in-patients : a multicentre, observational study

Background: The identification of older patients at risk of poor hospital outcomes (e.g. longer hospital stay, in-hospital mortality, and institutionalisation) is important to provide an effective healthcare service. Objective: To identify factors related to older patients’ clinical, nutritional, functional and socio-demographic profiles at admission to an acute care ward that can predict poor hospital outcomes. Design and Setting: The CRiteria to assess appropriate Medication use among Elderly complex patients project was a multicentre, observational study performed in geriatric and internal medicine acute care wards of seven Italian hospitals. Subjects: One thousand one hundred twenty-three consecutively admitted patients aged 65 years or older. Methods: Hospital outcomes were length of stay, in-hospital mortality, and institutionalisation. Results: Mean age of participants was 81 years, 56% were women. Median length of stay was 10 (7–14) days, 41 patients died during hospital stay and 37 were newly institutionalised. Number of drugs before admission, metastasized cancer, renal failure or dialysis, infection, falls at home during the last year, pain, and walking speed were independent predictors of LoS. Total dependency in activities of daily living and inability to perform grip strength test were independent predictors of inhospital mortality. Malnutrition and total dependency in activities of daily living were independent predictors of institutionalisation. Conclusions: Our results confirm that not only diseases, but also multifaceted aspects of ageing such as physical function and malnutrition are strong predictors of hospital outcomes and suggest that these variables should be systematically recorded

Physical function measurements to predict hospital outcome in older in-patients: results from the CRIME study

Background. Physical function measurements can predict health outcomes, such as mortality, in community-dwelling older persons. Few studies have examined the predictive value of physical performance measurements in acute hospital setting. In this study, we identified hospital outcome predictors in older in-patients by using a multi-component approach including physical performance measurements. Methods. Data are from the CRiteria to assess appropriate Medication use among Elderly complex patients (CRIME) project. This was a multicentre, observational study of 1123 older patients, consecutively admitted to geriatric and internal medicine acute care wards of seven Italian hospitals. Data on demographics, anthropometrics, social factors, cognitive status (Mini Mental State Examination), psychological status (15 items Geriatric Depression Scale), medical diagnoses, geriatric conditions, and physical function (walking speed, grip strength, ADL) were recorded. Hospital outcomes were length of stay, in-hospital mortality, and institutionalization. Results. Mean age of participants was 81 years, 56% were women. Median LoS was 10 (7-14) days, 41 patients died during hospital stay and 37 were newly institutionalized. Number of drugs before admission, metastasized cancer, renal failure or dialysis, infection, falls at home during the last year, pain, and walking speed were independent predictors of LoS. Inability to perform grip strength and total ADL dependency were independent predictors of in-hospital mortality. Malnutrition and total ADL dependency were independent predictors of institutionalization. Conclusions. Our findings demonstrate that the assessment of physical function is important to identify patients at risk of poor hospital outcome

Functional Changes during Hospital Stay in Older Patients Admitted to an Acute Care Ward: A Multicenter Observational Study

OBJECTIVES: Changes in physical performance during hospital stay have rarely been evaluated. In this study, we examined functional changes during hospital stay by assessing both physical performance and activities of daily living. Additionally, we investigated characteristics of older patients associated with meaningful in-hospital improvement in physical performance. METHODS: The CRiteria to assess appropriate Medication use among Elderly complex patients project recruited 1123 patients aged ≥65 years, consecutively admitted to geriatric or internal medicine acute care wards of seven Italian hospitals. We analyzed data from 639 participating participants with a Mini Mental State Examination score ≥18/30. Physical performance was assessed by walking speed and grip strength, and functional status by activities of daily living at hospital admission and at discharge. Meaningful improvement was defined as a measured change of at least 1 standard deviation. Multivariable logistic regression models predicting meaningful improvement, included age, gender, type of admission (through emergency room or elective), and physical performance at admission. RESULTS: Mean age of the study participants was 79 years (range 65-98), 52% were female. Overall, mean walking speed and grip strength performance improved during hospital stay (walking speed improvement: 0.04±0.20 m/s, p<0.001; grip strength improvement: 0.43±5.66 kg, p = 0.001), no significant change was observed in activities of daily living. Patients with poor physical performance at admission had higher odds for in-hospital improvement. CONCLUSION: Overall, physical performance measurements show an improvement during hospital stay. The margin for meaningful functional improvement is larger in patients with poor physical function at admission. Nevertheless, most of these patients continue to have poor performance at discharge

Functional changes during hospitalization in older patients admitted to an acute care ward: results from the CRIME study

Background. Impact of hospital stay on changes in physical performance has rarely been evaluated. In this study, we examined functional changes during hospital stay by assessing both physical performance and activities of daily living. Additionally, we investigated characteristics of older patients associated with meaningful in-hospital improvement in physical performance. Methods. Data are from the CRiteria to assess appropriate Medication use among Elderly complex patients project. This was a multicentre, observational study of 1123 older patients, consecutively admitted to geriatric and internal medicine acute care wards of seven Italian hospitals. We analyzed data from 639 participants with a Mini Mental State Examination score ≥18/30. Physical performance was assessed by walking speed and grip strength, and functional status by activities of daily living at hospital admission and at discharge. Meaningful improvement was defined as ≥1 standard deviation of in-hospital change of the examined measurement. Multivariate logistic regression models predicting meaningful improvement included age, gender, type of admission, and physical performance at admission. Results. The mean age of the study participants was 79 years, 52% were female. Overall, mean walking speed and grip strength performance improved during hospital stay (walking speed improvement: 0.04±0.20 m/s, p<0.001; grip strength improvement: 0.43±5.66 kg, p=0.001), no significant change was observed in activities of daily living. Patients with poor physical performance at admission had higher odds for in-hospital improvement. Conclusions. Our findings demonstrate that overall physical performance measurements show an improvement during hospital stay. The margin for meaningful functional improvement is larger in patients with poor physical function at admission. Nevertheless, most of these patients remain to have poor performance at discharge

Independent predictors of length of hospital stay.

<p>Analyses of length of hospital stay included number of drugs before admission, more than one hospital admission during the last year, comorbidity score, presence of heart failure, metastasized cancer, renal failure of infection, falls at home during the last year, pain, ADL score and walking speed category in a multivariate regression model with forward selection procedure and forced retention of centre, gender, age, and type of admission.</p><p>CI₉₅ = 95% confidence interval; ADL = Activities of Daily Living; BMI = Body Mass Index.</p><p>Independent predictors of length of hospital stay.</p

Characteristics of the study population (N = 1223).

<p>SD = Standard deviation; IQR = Interquartile range; BMI = Body Mass Index;</p><p>ADL = Activities of Daily Living.</p><p>Characteristics of the study population (N = 1223).</p