Background: Older dialysis patients have a high burden of mortality and morbidity. Frailty and functional disability are common. One of the main determinants of functional disability in nondialysis populations is acute hospitalization. Such episodes are predictive of increased mortality and a future need for long-term care. Based on the high prevalence of disability in the dialysis population, we undertook a pilot study to determine functional impairment at the time of admission and again at 1 week after discharge.
Study design: Prospective cohort study.
Setting & participants: Prevalent dialysis patients older than 65 years admitted to a single acute-care institution during a 3-month period.
Outcomes: The proportion of dialysis patients with difficulty with activities of daily living at baseline and 1 week after discharge.
Measurement: Basic activities of daily living; Lawton Brody Instrumental Activities of Daily Living score; timed up-and-go and handgrip tests; Trails A & B, and the clock test.
Results: At the time of admission, only 8 of 35 individuals reported being independent with basic activities of daily living. None of the patients was independent with instrumental activities of daily living. At 1 week after discharge, patients showed deterioration in all aspects of function except the ability to use the telephone and manage their financial affairs. A total of 73.3% of patients (95% confidence interval, 54.1 to 87.7) experienced a decline in personal functional independence in association with hospitalization.
Limitations: This is a pilot study with a small number of patients who were studied at only 2 times (admission and 1 week after discharge).
Conclusions: Results of this study suggest that hospitalization is associated with a high rate of disability in elderly dialysis patients. Further study is required to determine whether the functional deterioration seen with hospitalization improves over time.