Recovery of Activities of Daily Living in Older Adults After Hospitalization for Acute Medical Illness

Authors

  • Cynthia M. Boyd MD, MPH,

    1. From the *Division of Geriatric Medicine and Gerontology and Center on Aging and Health, Department of Medicine, School of Medicine, and Department of Health Policy and Management, Center on Aging and Health, and the Roger C. Lipitz Center for Integrated Health Care, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MarylandDivision of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, California§Interdisciplinary Research Program to Improve Care for Older Veterans and the Quality Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco, CaliforniaIndiana University Center for Aging Research, Indianapolis, Indiana#Division of Geriatric Medicine, University of Pittsburgh School Medical Center, Pittsburgh, Pennsylvania**Center on Aging and Division of Geriatrics, University of Connecticut Health Center, Farmington, Connecticut††School of Nursing, Department of Sociology and Bioethics, University Hospitals Case Medical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, GRE and ‡‡Department of Sociology and Bioethics, Case Western Reserve University, Cleveland, Ohio.
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  • C. Seth Landefeld MD,

    1. From the *Division of Geriatric Medicine and Gerontology and Center on Aging and Health, Department of Medicine, School of Medicine, and Department of Health Policy and Management, Center on Aging and Health, and the Roger C. Lipitz Center for Integrated Health Care, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MarylandDivision of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, California§Interdisciplinary Research Program to Improve Care for Older Veterans and the Quality Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco, CaliforniaIndiana University Center for Aging Research, Indianapolis, Indiana#Division of Geriatric Medicine, University of Pittsburgh School Medical Center, Pittsburgh, Pennsylvania**Center on Aging and Division of Geriatrics, University of Connecticut Health Center, Farmington, Connecticut††School of Nursing, Department of Sociology and Bioethics, University Hospitals Case Medical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, GRE and ‡‡Department of Sociology and Bioethics, Case Western Reserve University, Cleveland, Ohio.
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  • Steven R. Counsell MD,

    1. From the *Division of Geriatric Medicine and Gerontology and Center on Aging and Health, Department of Medicine, School of Medicine, and Department of Health Policy and Management, Center on Aging and Health, and the Roger C. Lipitz Center for Integrated Health Care, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MarylandDivision of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, California§Interdisciplinary Research Program to Improve Care for Older Veterans and the Quality Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco, CaliforniaIndiana University Center for Aging Research, Indianapolis, Indiana#Division of Geriatric Medicine, University of Pittsburgh School Medical Center, Pittsburgh, Pennsylvania**Center on Aging and Division of Geriatrics, University of Connecticut Health Center, Farmington, Connecticut††School of Nursing, Department of Sociology and Bioethics, University Hospitals Case Medical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, GRE and ‡‡Department of Sociology and Bioethics, Case Western Reserve University, Cleveland, Ohio.
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  • Robert M. Palmer MD, MPH,

    1. From the *Division of Geriatric Medicine and Gerontology and Center on Aging and Health, Department of Medicine, School of Medicine, and Department of Health Policy and Management, Center on Aging and Health, and the Roger C. Lipitz Center for Integrated Health Care, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MarylandDivision of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, California§Interdisciplinary Research Program to Improve Care for Older Veterans and the Quality Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco, CaliforniaIndiana University Center for Aging Research, Indianapolis, Indiana#Division of Geriatric Medicine, University of Pittsburgh School Medical Center, Pittsburgh, Pennsylvania**Center on Aging and Division of Geriatrics, University of Connecticut Health Center, Farmington, Connecticut††School of Nursing, Department of Sociology and Bioethics, University Hospitals Case Medical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, GRE and ‡‡Department of Sociology and Bioethics, Case Western Reserve University, Cleveland, Ohio.
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  • Richard H. Fortinsky PhD,

    1. From the *Division of Geriatric Medicine and Gerontology and Center on Aging and Health, Department of Medicine, School of Medicine, and Department of Health Policy and Management, Center on Aging and Health, and the Roger C. Lipitz Center for Integrated Health Care, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MarylandDivision of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, California§Interdisciplinary Research Program to Improve Care for Older Veterans and the Quality Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco, CaliforniaIndiana University Center for Aging Research, Indianapolis, Indiana#Division of Geriatric Medicine, University of Pittsburgh School Medical Center, Pittsburgh, Pennsylvania**Center on Aging and Division of Geriatrics, University of Connecticut Health Center, Farmington, Connecticut††School of Nursing, Department of Sociology and Bioethics, University Hospitals Case Medical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, GRE and ‡‡Department of Sociology and Bioethics, Case Western Reserve University, Cleveland, Ohio.
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  • Denise Kresevic RN, PhD,

    1. From the *Division of Geriatric Medicine and Gerontology and Center on Aging and Health, Department of Medicine, School of Medicine, and Department of Health Policy and Management, Center on Aging and Health, and the Roger C. Lipitz Center for Integrated Health Care, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MarylandDivision of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, California§Interdisciplinary Research Program to Improve Care for Older Veterans and the Quality Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco, CaliforniaIndiana University Center for Aging Research, Indianapolis, Indiana#Division of Geriatric Medicine, University of Pittsburgh School Medical Center, Pittsburgh, Pennsylvania**Center on Aging and Division of Geriatrics, University of Connecticut Health Center, Farmington, Connecticut††School of Nursing, Department of Sociology and Bioethics, University Hospitals Case Medical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, GRE and ‡‡Department of Sociology and Bioethics, Case Western Reserve University, Cleveland, Ohio.
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  • Christopher Burant MA, PhD,

    1. From the *Division of Geriatric Medicine and Gerontology and Center on Aging and Health, Department of Medicine, School of Medicine, and Department of Health Policy and Management, Center on Aging and Health, and the Roger C. Lipitz Center for Integrated Health Care, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MarylandDivision of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, California§Interdisciplinary Research Program to Improve Care for Older Veterans and the Quality Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco, CaliforniaIndiana University Center for Aging Research, Indianapolis, Indiana#Division of Geriatric Medicine, University of Pittsburgh School Medical Center, Pittsburgh, Pennsylvania**Center on Aging and Division of Geriatrics, University of Connecticut Health Center, Farmington, Connecticut††School of Nursing, Department of Sociology and Bioethics, University Hospitals Case Medical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, GRE and ‡‡Department of Sociology and Bioethics, Case Western Reserve University, Cleveland, Ohio.
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  • Kenneth E. Covinsky MD, MPH

    1. From the *Division of Geriatric Medicine and Gerontology and Center on Aging and Health, Department of Medicine, School of Medicine, and Department of Health Policy and Management, Center on Aging and Health, and the Roger C. Lipitz Center for Integrated Health Care, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MarylandDivision of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, California§Interdisciplinary Research Program to Improve Care for Older Veterans and the Quality Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco, CaliforniaIndiana University Center for Aging Research, Indianapolis, Indiana#Division of Geriatric Medicine, University of Pittsburgh School Medical Center, Pittsburgh, Pennsylvania**Center on Aging and Division of Geriatrics, University of Connecticut Health Center, Farmington, Connecticut††School of Nursing, Department of Sociology and Bioethics, University Hospitals Case Medical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, GRE and ‡‡Department of Sociology and Bioethics, Case Western Reserve University, Cleveland, Ohio.
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  • Preliminary results of this work were presented at the Gerontological Society of America Annual Meeting in November 2004.

Address correspondence to Cynthia M. Boyd, MD, MPH, Division of Geriatric Medicine and Gerontology and the Center on Aging and Health, Johns Hopkins University School of Medicine, Mason F. Lord Building, Center Tower, Seventh Floor, 5200 Eastern Avenue, Johns Hopkins Bayview Medical Campus, Baltimore, MD 21224. E-mail: cboyd1@jhmi.edu.

Abstract

OBJECTIVES: To compare functional outcomes in the year after discharge for older adults discharged from the hospital after an acute medical illness with a new or additional disability in their basic self-care activities of daily living (ADL) (compared with preadmission baseline 2 weeks before admission) with those of older adults discharged with baseline ADL function and identify predictors of failure to recover to baseline function 1 year after discharge.

DESIGN: Observational.

SETTING: Tertiary care hospital, community teaching hospital.

PARTICIPANTS: Older (aged ≥70) patients nonelectively admitted to general medical services (1993–1998).

MEASUREMENTS: Number of ADL disabilities at preadmission baseline and 1, 3, 6, and 12 months after discharge. Outcomes were death, sustained decline in ADL function, and recovery to baseline ADL function at each time point.

RESULTS: By 12 months after discharge, of those discharged with new or additional ADL disability, 41.3% died, 28.6% were alive but had not recovered to baseline function, and 30.1% were at baseline function. Of those discharged at baseline function, 17.8% died, 15.2% were alive but with worse than baseline function, and 67% were at their baseline function (P<.001). Of those discharged with new or additional ADL disability, the presence or absence of recovery by 1 month was associated with long-term outcomes. Age, cardiovascular disease, dementia, cancer, low albumin, and greater number of dependencies in instrumental ADLs independently predicted failure to recover.

CONCLUSION: For older adults discharged with new or additional disability in ADL after hospitalization for medical illness, prognosis for functional recovery is poor. Rehabilitation interventions of longer duration and timing than current reimbursement allows, caregiver support, and palliative care should be evaluated.

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