Trajectories and predictors of functional decline of hospitalised older patients

Authors

  • Hui-Tzu Huang RN, MSN, PhD Candidate,

    1. Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Taiwan
    2. Lecturer, Department of Nursing, Chung Hwa University of Medical Technology, Tainan City, Taiwan
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  • Chia-Ming Chang MD,

    Associate Professor
    1. Division of Geriatrics and Gerontology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan City, Taiwan
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  • Li-Fan Liu PhD,

    Associate Professor
    1. Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
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  • Huey-Shyan Lin PhD,

    Associate Professor
    1. Program of Health-Business Administration, Fooyin University, Kaohsiung City, Taiwan
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  • Ching-Huey Chen PhD, RN

    Professor, Corresponding author
    1. Department of Nursing, Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
    • Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Taiwan
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Correspondence: Ching-Huey Chen, Professor, Department of Nursing, Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan City 70101, Taiwan.

Telephone: +886-6-235-3535 ext. 5834.

E-mail: sugar@mail.ncku.edu.tw

Abstract

Aims and objectives

To delineate the trajectories of functional status over four time points and to examine predictors of functional decline (FD) in hospitalised older patients.

Background

About 30–60% of the older patients develop new dependence in activities of daily living (ADL) during a hospital stay, which results in progressive disability after discharge. The functional trajectories and risk factors of FD among hospitalised older patients require identification.

Design

A cohort study.

Methods

The study consecutively recruited 273 patients aged 65 and older admitted to a medical centre in southern Taiwan. Functional trajectory, by ADL score, was observed at four time points: two weeks before admission, admission, discharge and three months after discharge. The ADL score two weeks before admission was used as a baseline functional status.

Results

Eighty-three (30·4%) patients experienced FD at three months after discharge. Functional trajectory as shown by ADL scores indicated that all 273 patients dropped steeply at admission and that two-thirds were gradually restored three months after discharge. Logistic regression revealed that the number of falls in the past year, Instrument Activities of Daily Living (IADL) status before admission, comorbidity and ADL decline between preadmission and discharge were significant predictors of FD three months after discharge. The ADL score decline during hospitalisation was the mediator of FD three months after discharge.

Conclusions

Findings indicate that the ADL function of those hospitalised older patients who reported having fallen more often in the previous year had more comorbidity, had a lower IADL score, and had more ADL score decline before admission and discharge would continue to decline after discharge.

Relevance to clinical practice

Clinical nurses can integrate the finding of this study with Comprehensive Geriatric Assessment to tailor intervention to restore older patient's physical function during hospitalisation.

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