Functional deterioration in the month before hospitalisation is associated with in-hospital functional decline: an observational study

Danielle Ní Chróinín; David Basic; David Conforti; Chris Shanley

doi:10.1007/s41999-018-0041-7

Functional deterioration in the month before hospitalisation is associated with in-hospital functional decline: an observational study

Eur Geriatr Med. 2018 Jun;9(3):321-327. doi: 10.1007/s41999-018-0041-7. Epub 2018 Mar 14.

Authors

Danielle Ní Chróinín^{1

2}, David Basic³, David Conforti⁴, Chris Shanley^{5

6}

Affiliations

¹ Department of Geriatric Medicine, Liverpool Hospital, Locked Mail Bag 7103, Liverpool, 1871, NSW, Australia. dmmnic@umail.ucc.ie.
² UNSW South Western Sydney Clinical School, UNSW, Liverpool, Australia. dmmnic@umail.ucc.ie.
³ Department of Geriatric Medicine, Liverpool Hospital, Locked Mail Bag 7103, Liverpool, 1871, NSW, Australia. david.basic@sswahs.nsw.gov.au.
⁴ Department of Geriatric Medicine, Liverpool Hospital, Locked Mail Bag 7103, Liverpool, 1871, NSW, Australia.
⁵ Centre for Applied Nursing Research, Western Sydney University, Sydney, Australia.
⁶ Ingham Institute of Applied Medical Research, Liverpool, Australia.

PMID: 34654235
DOI: 10.1007/s41999-018-0041-7

Abstract

Introduction: Functional deterioration preceding acute hospital admission may be associated with poorer in-hospital outcomes. We sought to investigate the association between functional decline in the month preceding admission and in-hospital outcomes.

Materials and methods: Consecutive patients admitted under geriatric medicine over 5 years were prospectively included. Pre-hospital decline was defined as decrease in Modified Barthel Index (MBI) between pre-morbid status (1 month prior) and admission. The primary outcome was in-hospital functional decline (decline in MBI and/or new assistance/aid to mobilise). Secondary outcomes included length-of-stay (LOS; highest quartile), in-hospital falls and death.

Results: Amongst 1458 patients (mean age 82.0; 60.91% female), 76.89% (1121/1458) experienced pre-hospital MBI decline. On univariate logistic regression, pre-hospital MBI decline was associated with in-hospital functional decline (OR 15.83, p < 0.001). Adjusting for age, nursing home residence, pre-morbid MBI, in-hospital referral source, dementia, adverse drug reaction and number of active diagnoses, pre-hospital decline was independently associated with in-hospital functional decline (OR 15.22, CI 10.89-21.26, p < 0.001). On univariate analysis, those with pre-hospital decline had more in-hospital falls (OR 2. 91, p = 0.02). Adjusting for age, sex, dementia, number of active diagnoses, and ambulation, no strong association was observed between pre-hospital decline and in-hospital falls (OR 1.86, p = 0.08). Prolonged LOS ≥ 20 days was more common amongst patients with pre-hospital decline on univariate (OR 1.95, p < 0.001) but not adjusted analyses (p = 0.14). No association was observed with in-hospital death.

Conclusion: Pre-hospital functional decline was associated with poorer in-hospital functional outcomes. Exploration of early interventions to optimise function in such patients is needed.

Keywords: Activities of daily living; Frail elderly; Function; Hospitalisation; Patient outcome assessment.