Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: Increased vulnerability with age

Kenneth E. Covinsky, Robert M. Palmer, Richard H. Fortinsky, Steven Counsell, Anita L. Stewart, Denise Kresevic, Christopher J. Burant, C. Seth Landefeld

Research output: Contribution to journalArticle

766 Citations (Scopus)

Abstract

OBJECTIVES: To describe the changes in activities of daily living (ADL) function occurring before and after hospital admission in older people hospitalized with medical illness and to assess the effect of age on loss of ADL function. DESIGN: Prospective observational study. SETTING: The general medical service of two hospitals. PARTICIPANTS: Two thousand two hundred ninety-three patients aged 70 and older (mean age 80, 64% women, 24% nonwhite). MEASUREMENTS: At the time of hospital admission, patients or their surrogates were interviewed about their independence in five ADLs (bathing, dressing, eating, transferring, and toileting) 2 weeks before admission (baseline) and at admission. Subjects were interviewed about ADL function at discharge. Outcome measures included functional decline between baseline and discharge and functional changes between baseline and admission and between admission and discharge. RESULTS: Thirty-five percent of patients declined in ADL function between baseline and discharge. This included the 23% of patients who declined between baseline and admission and failed to recover to baseline function between admission and discharge and the 12% of patients who did not decline between baseline and admission but declined between hospital admission and discharge. Twenty percent of patients declined between baseline and admission but recovered to baseline function between admission and discharge. The frequency of ADL decline between baseline and discharge varied markedly with age (23%, 28%, 38%, 50%, and 63% in patients aged 70-74, 75-79, 80-84, 85-89, and ≥90, respectively, P <.001). After adjustment for potential confounders, age was not associated with ADL decline before hospitalization (odds ratio (OR) for patients aged ≥90 compared with patients aged 70-74 = 1.26, 95% confidence interval (CI) = 0.88-1.82). In contrast, age was associated with the failure to recover ADL function during hospitalization in patients who declined before admission (OR for patients aged ≤90 compared with patients aged 70-74 = 2.09, 95% CI = 1.20-3.65) and with new losses of ADL function during hospitalization in patients who did not decline before admission (OR for patients aged ≥90 compared with patients aged 70-74 = 3.43, 95% CI = 1.92-6.12). CONCLUSION: Many hospitalized older people are discharged with ADL function that is worse than their baseline function. The oldest patients are at particularly high risk of poor functional outcomes because they are less likely to recover ADL function lost before admission and more likely to develop new functional deficits during hospitalization.

Original languageEnglish (US)
Pages (from-to)451-458
Number of pages8
JournalJournal of the American Geriatrics Society
Volume51
Issue number4
DOIs
StatePublished - Apr 1 2003
Externally publishedYes

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Activities of Daily Living
Hospitalization
Odds Ratio
Confidence Intervals
Patient Discharge
Patient Admission
Bandages
Observational Studies
Eating
Outcome Assessment (Health Care)

Keywords

  • Activities of daily living
  • Frail elderly
  • Geriatric assessment
  • Health status
  • Hospitalization

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Loss of independence in activities of daily living in older adults hospitalized with medical illnesses : Increased vulnerability with age. / Covinsky, Kenneth E.; Palmer, Robert M.; Fortinsky, Richard H.; Counsell, Steven; Stewart, Anita L.; Kresevic, Denise; Burant, Christopher J.; Landefeld, C. Seth.

In: Journal of the American Geriatrics Society, Vol. 51, No. 4, 01.04.2003, p. 451-458.

Research output: Contribution to journalArticle

Covinsky, Kenneth E. ; Palmer, Robert M. ; Fortinsky, Richard H. ; Counsell, Steven ; Stewart, Anita L. ; Kresevic, Denise ; Burant, Christopher J. ; Landefeld, C. Seth. / Loss of independence in activities of daily living in older adults hospitalized with medical illnesses : Increased vulnerability with age. In: Journal of the American Geriatrics Society. 2003 ; Vol. 51, No. 4. pp. 451-458.
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abstract = "OBJECTIVES: To describe the changes in activities of daily living (ADL) function occurring before and after hospital admission in older people hospitalized with medical illness and to assess the effect of age on loss of ADL function. DESIGN: Prospective observational study. SETTING: The general medical service of two hospitals. PARTICIPANTS: Two thousand two hundred ninety-three patients aged 70 and older (mean age 80, 64{\%} women, 24{\%} nonwhite). MEASUREMENTS: At the time of hospital admission, patients or their surrogates were interviewed about their independence in five ADLs (bathing, dressing, eating, transferring, and toileting) 2 weeks before admission (baseline) and at admission. Subjects were interviewed about ADL function at discharge. Outcome measures included functional decline between baseline and discharge and functional changes between baseline and admission and between admission and discharge. RESULTS: Thirty-five percent of patients declined in ADL function between baseline and discharge. This included the 23{\%} of patients who declined between baseline and admission and failed to recover to baseline function between admission and discharge and the 12{\%} of patients who did not decline between baseline and admission but declined between hospital admission and discharge. Twenty percent of patients declined between baseline and admission but recovered to baseline function between admission and discharge. The frequency of ADL decline between baseline and discharge varied markedly with age (23{\%}, 28{\%}, 38{\%}, 50{\%}, and 63{\%} in patients aged 70-74, 75-79, 80-84, 85-89, and ≥90, respectively, P <.001). After adjustment for potential confounders, age was not associated with ADL decline before hospitalization (odds ratio (OR) for patients aged ≥90 compared with patients aged 70-74 = 1.26, 95{\%} confidence interval (CI) = 0.88-1.82). In contrast, age was associated with the failure to recover ADL function during hospitalization in patients who declined before admission (OR for patients aged ≤90 compared with patients aged 70-74 = 2.09, 95{\%} CI = 1.20-3.65) and with new losses of ADL function during hospitalization in patients who did not decline before admission (OR for patients aged ≥90 compared with patients aged 70-74 = 3.43, 95{\%} CI = 1.92-6.12). CONCLUSION: Many hospitalized older people are discharged with ADL function that is worse than their baseline function. The oldest patients are at particularly high risk of poor functional outcomes because they are less likely to recover ADL function lost before admission and more likely to develop new functional deficits during hospitalization.",
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T1 - Loss of independence in activities of daily living in older adults hospitalized with medical illnesses

T2 - Increased vulnerability with age

AU - Covinsky, Kenneth E.

AU - Palmer, Robert M.

AU - Fortinsky, Richard H.

AU - Counsell, Steven

AU - Stewart, Anita L.

AU - Kresevic, Denise

AU - Burant, Christopher J.

AU - Landefeld, C. Seth

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N2 - OBJECTIVES: To describe the changes in activities of daily living (ADL) function occurring before and after hospital admission in older people hospitalized with medical illness and to assess the effect of age on loss of ADL function. DESIGN: Prospective observational study. SETTING: The general medical service of two hospitals. PARTICIPANTS: Two thousand two hundred ninety-three patients aged 70 and older (mean age 80, 64% women, 24% nonwhite). MEASUREMENTS: At the time of hospital admission, patients or their surrogates were interviewed about their independence in five ADLs (bathing, dressing, eating, transferring, and toileting) 2 weeks before admission (baseline) and at admission. Subjects were interviewed about ADL function at discharge. Outcome measures included functional decline between baseline and discharge and functional changes between baseline and admission and between admission and discharge. RESULTS: Thirty-five percent of patients declined in ADL function between baseline and discharge. This included the 23% of patients who declined between baseline and admission and failed to recover to baseline function between admission and discharge and the 12% of patients who did not decline between baseline and admission but declined between hospital admission and discharge. Twenty percent of patients declined between baseline and admission but recovered to baseline function between admission and discharge. The frequency of ADL decline between baseline and discharge varied markedly with age (23%, 28%, 38%, 50%, and 63% in patients aged 70-74, 75-79, 80-84, 85-89, and ≥90, respectively, P <.001). After adjustment for potential confounders, age was not associated with ADL decline before hospitalization (odds ratio (OR) for patients aged ≥90 compared with patients aged 70-74 = 1.26, 95% confidence interval (CI) = 0.88-1.82). In contrast, age was associated with the failure to recover ADL function during hospitalization in patients who declined before admission (OR for patients aged ≤90 compared with patients aged 70-74 = 2.09, 95% CI = 1.20-3.65) and with new losses of ADL function during hospitalization in patients who did not decline before admission (OR for patients aged ≥90 compared with patients aged 70-74 = 3.43, 95% CI = 1.92-6.12). CONCLUSION: Many hospitalized older people are discharged with ADL function that is worse than their baseline function. The oldest patients are at particularly high risk of poor functional outcomes because they are less likely to recover ADL function lost before admission and more likely to develop new functional deficits during hospitalization.

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KW - Activities of daily living

KW - Frail elderly

KW - Geriatric assessment

KW - Health status

KW - Hospitalization

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