Hospitalization and Change in Body Composition and Strength in a Population-Based Cohort of Older Persons

Authors

  • Dawn E. Alley PhD,

    1. From the *Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland; Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland; Research Institute, California Pacific Medical Center, San Francisco, California; §Longitudinal Studies Section, National Institute on Aging, Baltimore, Maryland; Departments of Medicine and §§Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; #Veterans Affairs Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California; **Sticht Center on Aging, School of Medicine, Wake Forest University, Winston-Salem, North Carolina; ††College of Public Health, University of Georgia, Athens, Georgia; and ‡‡Department of Epidemiology, University of Tennessee, Memphis, Tennessee.
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  • Annemarie Koster PhD,

    1. From the *Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland; Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland; Research Institute, California Pacific Medical Center, San Francisco, California; §Longitudinal Studies Section, National Institute on Aging, Baltimore, Maryland; Departments of Medicine and §§Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; #Veterans Affairs Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California; **Sticht Center on Aging, School of Medicine, Wake Forest University, Winston-Salem, North Carolina; ††College of Public Health, University of Georgia, Athens, Georgia; and ‡‡Department of Epidemiology, University of Tennessee, Memphis, Tennessee.
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  • Dawn Mackey PhD,

    1. From the *Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland; Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland; Research Institute, California Pacific Medical Center, San Francisco, California; §Longitudinal Studies Section, National Institute on Aging, Baltimore, Maryland; Departments of Medicine and §§Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; #Veterans Affairs Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California; **Sticht Center on Aging, School of Medicine, Wake Forest University, Winston-Salem, North Carolina; ††College of Public Health, University of Georgia, Athens, Georgia; and ‡‡Department of Epidemiology, University of Tennessee, Memphis, Tennessee.
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  • Peggy Cawthon PhD, MPH,

    1. From the *Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland; Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland; Research Institute, California Pacific Medical Center, San Francisco, California; §Longitudinal Studies Section, National Institute on Aging, Baltimore, Maryland; Departments of Medicine and §§Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; #Veterans Affairs Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California; **Sticht Center on Aging, School of Medicine, Wake Forest University, Winston-Salem, North Carolina; ††College of Public Health, University of Georgia, Athens, Georgia; and ‡‡Department of Epidemiology, University of Tennessee, Memphis, Tennessee.
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  • Luigi Ferrucci MD, PhD,

    1. From the *Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland; Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland; Research Institute, California Pacific Medical Center, San Francisco, California; §Longitudinal Studies Section, National Institute on Aging, Baltimore, Maryland; Departments of Medicine and §§Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; #Veterans Affairs Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California; **Sticht Center on Aging, School of Medicine, Wake Forest University, Winston-Salem, North Carolina; ††College of Public Health, University of Georgia, Athens, Georgia; and ‡‡Department of Epidemiology, University of Tennessee, Memphis, Tennessee.
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  • Eleanor M. Simonsick PhD,

    1. From the *Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland; Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland; Research Institute, California Pacific Medical Center, San Francisco, California; §Longitudinal Studies Section, National Institute on Aging, Baltimore, Maryland; Departments of Medicine and §§Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; #Veterans Affairs Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California; **Sticht Center on Aging, School of Medicine, Wake Forest University, Winston-Salem, North Carolina; ††College of Public Health, University of Georgia, Athens, Georgia; and ‡‡Department of Epidemiology, University of Tennessee, Memphis, Tennessee.
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  • Binbing Yu PhD,

    1. From the *Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland; Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland; Research Institute, California Pacific Medical Center, San Francisco, California; §Longitudinal Studies Section, National Institute on Aging, Baltimore, Maryland; Departments of Medicine and §§Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; #Veterans Affairs Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California; **Sticht Center on Aging, School of Medicine, Wake Forest University, Winston-Salem, North Carolina; ††College of Public Health, University of Georgia, Athens, Georgia; and ‡‡Department of Epidemiology, University of Tennessee, Memphis, Tennessee.
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  • Susan Hardy MD, PhD,

    1. From the *Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland; Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland; Research Institute, California Pacific Medical Center, San Francisco, California; §Longitudinal Studies Section, National Institute on Aging, Baltimore, Maryland; Departments of Medicine and §§Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; #Veterans Affairs Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California; **Sticht Center on Aging, School of Medicine, Wake Forest University, Winston-Salem, North Carolina; ††College of Public Health, University of Georgia, Athens, Georgia; and ‡‡Department of Epidemiology, University of Tennessee, Memphis, Tennessee.
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  • Bret Goodpaster PhD,

    1. From the *Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland; Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland; Research Institute, California Pacific Medical Center, San Francisco, California; §Longitudinal Studies Section, National Institute on Aging, Baltimore, Maryland; Departments of Medicine and §§Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; #Veterans Affairs Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California; **Sticht Center on Aging, School of Medicine, Wake Forest University, Winston-Salem, North Carolina; ††College of Public Health, University of Georgia, Athens, Georgia; and ‡‡Department of Epidemiology, University of Tennessee, Memphis, Tennessee.
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  • Catherine Sarkisian MD, MPH,

    1. From the *Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland; Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland; Research Institute, California Pacific Medical Center, San Francisco, California; §Longitudinal Studies Section, National Institute on Aging, Baltimore, Maryland; Departments of Medicine and §§Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; #Veterans Affairs Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California; **Sticht Center on Aging, School of Medicine, Wake Forest University, Winston-Salem, North Carolina; ††College of Public Health, University of Georgia, Athens, Georgia; and ‡‡Department of Epidemiology, University of Tennessee, Memphis, Tennessee.
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  • Denise K. Houston PhD,

    1. From the *Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland; Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland; Research Institute, California Pacific Medical Center, San Francisco, California; §Longitudinal Studies Section, National Institute on Aging, Baltimore, Maryland; Departments of Medicine and §§Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; #Veterans Affairs Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California; **Sticht Center on Aging, School of Medicine, Wake Forest University, Winston-Salem, North Carolina; ††College of Public Health, University of Georgia, Athens, Georgia; and ‡‡Department of Epidemiology, University of Tennessee, Memphis, Tennessee.
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  • Stephen B. Kritchevsky PhD,

    1. From the *Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland; Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland; Research Institute, California Pacific Medical Center, San Francisco, California; §Longitudinal Studies Section, National Institute on Aging, Baltimore, Maryland; Departments of Medicine and §§Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; #Veterans Affairs Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California; **Sticht Center on Aging, School of Medicine, Wake Forest University, Winston-Salem, North Carolina; ††College of Public Health, University of Georgia, Athens, Georgia; and ‡‡Department of Epidemiology, University of Tennessee, Memphis, Tennessee.
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  • Steven Cummings MD,

    1. From the *Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland; Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland; Research Institute, California Pacific Medical Center, San Francisco, California; §Longitudinal Studies Section, National Institute on Aging, Baltimore, Maryland; Departments of Medicine and §§Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; #Veterans Affairs Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California; **Sticht Center on Aging, School of Medicine, Wake Forest University, Winston-Salem, North Carolina; ††College of Public Health, University of Georgia, Athens, Georgia; and ‡‡Department of Epidemiology, University of Tennessee, Memphis, Tennessee.
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  • Jung-Sun Lee PhD,

    1. From the *Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland; Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland; Research Institute, California Pacific Medical Center, San Francisco, California; §Longitudinal Studies Section, National Institute on Aging, Baltimore, Maryland; Departments of Medicine and §§Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; #Veterans Affairs Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California; **Sticht Center on Aging, School of Medicine, Wake Forest University, Winston-Salem, North Carolina; ††College of Public Health, University of Georgia, Athens, Georgia; and ‡‡Department of Epidemiology, University of Tennessee, Memphis, Tennessee.
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  • Frances A. Tylavsky PhD,

    1. From the *Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland; Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland; Research Institute, California Pacific Medical Center, San Francisco, California; §Longitudinal Studies Section, National Institute on Aging, Baltimore, Maryland; Departments of Medicine and §§Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; #Veterans Affairs Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California; **Sticht Center on Aging, School of Medicine, Wake Forest University, Winston-Salem, North Carolina; ††College of Public Health, University of Georgia, Athens, Georgia; and ‡‡Department of Epidemiology, University of Tennessee, Memphis, Tennessee.
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  • Anne Newman MD, MPH,

    1. From the *Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland; Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland; Research Institute, California Pacific Medical Center, San Francisco, California; §Longitudinal Studies Section, National Institute on Aging, Baltimore, Maryland; Departments of Medicine and §§Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; #Veterans Affairs Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California; **Sticht Center on Aging, School of Medicine, Wake Forest University, Winston-Salem, North Carolina; ††College of Public Health, University of Georgia, Athens, Georgia; and ‡‡Department of Epidemiology, University of Tennessee, Memphis, Tennessee.
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  • Tamara Harris MD, MSc,

    1. From the *Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland; Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland; Research Institute, California Pacific Medical Center, San Francisco, California; §Longitudinal Studies Section, National Institute on Aging, Baltimore, Maryland; Departments of Medicine and §§Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; #Veterans Affairs Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California; **Sticht Center on Aging, School of Medicine, Wake Forest University, Winston-Salem, North Carolina; ††College of Public Health, University of Georgia, Athens, Georgia; and ‡‡Department of Epidemiology, University of Tennessee, Memphis, Tennessee.
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  • for the Health, Aging and Body Composition Study

    1. From the *Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland; Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland; Research Institute, California Pacific Medical Center, San Francisco, California; §Longitudinal Studies Section, National Institute on Aging, Baltimore, Maryland; Departments of Medicine and §§Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; #Veterans Affairs Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California; **Sticht Center on Aging, School of Medicine, Wake Forest University, Winston-Salem, North Carolina; ††College of Public Health, University of Georgia, Athens, Georgia; and ‡‡Department of Epidemiology, University of Tennessee, Memphis, Tennessee.
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  • Preliminary results were presented at the Gerontological Society of America meeting, Atlanta, Georgia, November 21, 2009.

Address correspondence to Dawn E. Alley, University of Maryland School of Medicine, Department of Epidemiology and Public Health, Baltimore, MD 21201. E-mail: dalley@epi.umaryland.edu

Abstract

OBJECTIVES: To examine the association between hospitalization and annual changes in body composition and strength in older adults.

DESIGN: Cohort study.

SETTING: Clinic examinations in Pittsburgh, Pennsylvania, or Memphis, Tennessee.

PARTICIPANTS: Well-functioning adults aged 70 to 79 who participated in the Health, Aging and Body Composition Study.

MEASUREMENTS: Hospitalizations were reported at annual clinic visits and in semiannual phone interviews. In the event of death or reported hospitalization, hospitalizations were adjudicated according to medical record review. Dual X-ray absorptiometry (DXA) assessments of total, lean, and fat mass were conducted in six annual examinations, and measures of knee extensor strength were conducted in two annual examinations.

RESULTS: DXA assessments followed 2,309 hospitalizations. In men and women, hospitalization in the previous year was associated with greater declines in total mass (−0.76 and −0.81 kg, respectively), fat mass (−0.41 and −0.54 kg), and lean mass (−0.33 and −0.25 kg) (P<.001 for all) than in nonhospitalized participants, after adjustment for demographics and baseline values. Hospitalization was associated with strength declines in men (−4.02 Nm, P=.046) but not in women. Relationships were similar after adjusting for health behaviors and chronic conditions, although the association between hospitalization and strength was attenuated. Associations increased with number of days hospitalized; hospitalizations totaling 8 days or more in the previous year were associated with significantly greater loss of total, lean, and fat mass and loss of strength in both sexes than in nonhospitalized participants.

CONCLUSION: Hospitalization is associated with significant changes in body composition and strength in older persons. These effects appear particularly important in persons hospitalized for 8 or more days per year.

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