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A Clinical Index to Stratify Hospitalized Older Adults According to Risk for New-Onset Disability

Authors

  • Kala M. Mehta DSc, MPH,

    1. From the *Division of Geriatrics, Department of Epidemiology and Biostatistics, §Department of Dermatology, University of California at San Francisco, San Francisco, California; Health Services Research Enhancement Award Program, San Francisco Veterans Affairs Medical Center, San Francisco, California; Division of Geriatric Medicine and Gerontology, University of Pittsburgh, Pittsburgh, Pennsylvania; and #Indiana University Center for Aging Research and **Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana.
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  • Edgar Pierluissi MD,

    1. From the *Division of Geriatrics, Department of Epidemiology and Biostatistics, §Department of Dermatology, University of California at San Francisco, San Francisco, California; Health Services Research Enhancement Award Program, San Francisco Veterans Affairs Medical Center, San Francisco, California; Division of Geriatric Medicine and Gerontology, University of Pittsburgh, Pittsburgh, Pennsylvania; and #Indiana University Center for Aging Research and **Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana.
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  • W. John Boscardin PhD,

    1. From the *Division of Geriatrics, Department of Epidemiology and Biostatistics, §Department of Dermatology, University of California at San Francisco, San Francisco, California; Health Services Research Enhancement Award Program, San Francisco Veterans Affairs Medical Center, San Francisco, California; Division of Geriatric Medicine and Gerontology, University of Pittsburgh, Pittsburgh, Pennsylvania; and #Indiana University Center for Aging Research and **Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana.
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  • Katharine A. Kirby MS,

    1. From the *Division of Geriatrics, Department of Epidemiology and Biostatistics, §Department of Dermatology, University of California at San Francisco, San Francisco, California; Health Services Research Enhancement Award Program, San Francisco Veterans Affairs Medical Center, San Francisco, California; Division of Geriatric Medicine and Gerontology, University of Pittsburgh, Pittsburgh, Pennsylvania; and #Indiana University Center for Aging Research and **Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana.
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  • Louise C. Walter MD,

    1. From the *Division of Geriatrics, Department of Epidemiology and Biostatistics, §Department of Dermatology, University of California at San Francisco, San Francisco, California; Health Services Research Enhancement Award Program, San Francisco Veterans Affairs Medical Center, San Francisco, California; Division of Geriatric Medicine and Gerontology, University of Pittsburgh, Pittsburgh, Pennsylvania; and #Indiana University Center for Aging Research and **Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana.
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  • Mary-Margaret Chren MD,

    1. From the *Division of Geriatrics, Department of Epidemiology and Biostatistics, §Department of Dermatology, University of California at San Francisco, San Francisco, California; Health Services Research Enhancement Award Program, San Francisco Veterans Affairs Medical Center, San Francisco, California; Division of Geriatric Medicine and Gerontology, University of Pittsburgh, Pittsburgh, Pennsylvania; and #Indiana University Center for Aging Research and **Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana.
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  • Robert M. Palmer MD, MPH,

    1. From the *Division of Geriatrics, Department of Epidemiology and Biostatistics, §Department of Dermatology, University of California at San Francisco, San Francisco, California; Health Services Research Enhancement Award Program, San Francisco Veterans Affairs Medical Center, San Francisco, California; Division of Geriatric Medicine and Gerontology, University of Pittsburgh, Pittsburgh, Pennsylvania; and #Indiana University Center for Aging Research and **Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana.
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  • Steven R. Counsell MD,

    1. From the *Division of Geriatrics, Department of Epidemiology and Biostatistics, §Department of Dermatology, University of California at San Francisco, San Francisco, California; Health Services Research Enhancement Award Program, San Francisco Veterans Affairs Medical Center, San Francisco, California; Division of Geriatric Medicine and Gerontology, University of Pittsburgh, Pittsburgh, Pennsylvania; and #Indiana University Center for Aging Research and **Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana.
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  • C. Seth Landefeld MD

    1. From the *Division of Geriatrics, Department of Epidemiology and Biostatistics, §Department of Dermatology, University of California at San Francisco, San Francisco, California; Health Services Research Enhancement Award Program, San Francisco Veterans Affairs Medical Center, San Francisco, California; Division of Geriatric Medicine and Gerontology, University of Pittsburgh, Pittsburgh, Pennsylvania; and #Indiana University Center for Aging Research and **Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana.
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Address correspondence to Kala M. Mehta, Assistant Professor, Division of Geriatrics, University of California, San Francisco, 4150 Clement Street, Box 181G, San Francisco, CA 94121. E-mail: Kala.mehta@ucsf.edu

Abstract

BACKGROUND: Many older adults who are independent prior to hospitalization develop a new disability by hospital discharge. Early risk stratification for new-onset disability may improve care. Thus, this study's objective was to develop and validate a clinical index to determine, at admission, risk for new-onset disability among older, hospitalized adults at discharge.

DESIGN: Data analyses derived from two prospective studies.

SETTING: Two teaching hospitals in Ohio.

PARTICIPANTS: Eight hundred eighty-five patients aged 70 years and older were discharged from a general medical service at a tertiary care hospital (mean age 78, 59% female) and 753 patients discharged from a separate community teaching hospital (mean age 79, 63% female). All participants reported being independent in five activities of daily living (ADLs: bathing, dressing, transferring, toileting, and eating) 2 weeks before admission.

MEASUREMENTS: New-onset disability, defined as a new need for personal assistance in one or more ADLs at discharge in participants who were independent 2 weeks before hospital admission.

RESULTS: Seven independent risk factors known on admission were identified and weighted using logistic regression: age (80–89, 1 point; ≥90, 2 points); dependence in three or more instrumental ADLs at baseline (2 points); impaired mobility at baseline (unable to run, 1 point; unable to climb stairs, 2 points); dependence in ADLs at admission (2–3 ADLs, 1 point; 4–5 ADLs, 3 points); acute stroke or metastatic cancer (2 points); severe cognitive impairment (1 point); and albumin less than 3.0 g/dL (2 points). New-onset disability occurred in 6%, 13%, 18%, 34%, 35%, 45%, 50%, and 87% of participants with 0, 1, 2, 3, 4, 5, 6, and 7 or more points, respectively, in the derivation cohort (area under the receiver operating characteristic curve (AUC)=0.784), and in 8%, 10%, 27%, 38%, 44%, 45%, 58%, and 83%, respectively, in the validation cohort (AUC=0.784). The risk score also predicted (P<.001) disability severity, nursing home placement, and long-term survival.

CONCLUSION: This clinical index determines risk for new-onset disability in hospitalized older adults and may inform clinical care.

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