Recovery of activities of daily living in older adults after hospitalization for acute medical illness

Abstract

Objectives: To compare functional outcomes in the year after discharge for older adults discharged from the hospital after an acute medical illness with a new or additional disability in their basic self-care activities of daily living (ADL) (compared with preadmission baseline 2 weeks before admission) with those of older adults discharged with baseline ADL function and identify predictors of failure to recover to baseline function 1 year after discharge.

Design: Observational.

Setting: Tertiary care hospital, community teaching hospital.

Participants: Older (aged >or=70) patients nonelectively admitted to general medical services (1993-1998).

Measurements: Number of ADL disabilities at preadmission baseline and 1, 3, 6, and 12 months after discharge. Outcomes were death, sustained decline in ADL function, and recovery to baseline ADL function at each time point.

Results: By 12 months after discharge, of those discharged with new or additional ADL disability, 41.3% died, 28.6% were alive but had not recovered to baseline function, and 30.1% were at baseline function. Of those discharged at baseline function, 17.8% died, 15.2% were alive but with worse than baseline function, and 67% were at their baseline function (P<.001). Of those discharged with new or additional ADL disability, the presence or absence of recovery by 1 month was associated with long-term outcomes. Age, cardiovascular disease, dementia, cancer, low albumin, and greater number of dependencies in instrumental ADLs independently predicted failure to recover.

Conclusion: For older adults discharged with new or additional disability in ADL after hospitalization for medical illness, prognosis for functional recovery is poor. Rehabilitation interventions of longer duration and timing than current reimbursement allows, caregiver support, and palliative care should be evaluated.

Figure 1. Derivation of the Analytic Sample and Study Definitions

1.1) Derivation of the analytic Sample 1.2) Trajectories of Function in Self-care Activities of Daily Living (ADL): Baseline Through Hospital Discharge Footnote: Group 1: Discharged with Baseline Self-Care Activities of Daily Living (ADL) Function Trajectory a: patients who had stable function throughout their course with no decline in self-care ADL function between baseline and admission and no decline between admission and discharge. Trajectory b: patients who declined in self-care ADL function between baseline and hospital admission, but recovered to baseline self-care ADL function by the time of hospital discharge. Group 2: Discharged with New or Additional Disability in self-care ADL (decline in self-care ADL function) Trajectory c: Patients acquiring new or additional disability in self-care ADL between baseline and admission who did not recover to baseline function by the time of hospital discharge Trajectory d: Patients who did not decline in self-care ADL function between baseline and admission but acquired new or additional disability in self-care ADL between admission and discharge.

Figure 1. Derivation of the Analytic Sample and Study Definitions

1.1) Derivation of the analytic Sample 1.2) Trajectories of Function in Self-care Activities of Daily Living (ADL): Baseline Through Hospital Discharge Footnote: Group 1: Discharged with Baseline Self-Care Activities of Daily Living (ADL) Function Trajectory a: patients who had stable function throughout their course with no decline in self-care ADL function between baseline and admission and no decline between admission and discharge. Trajectory b: patients who declined in self-care ADL function between baseline and hospital admission, but recovered to baseline self-care ADL function by the time of hospital discharge. Group 2: Discharged with New or Additional Disability in self-care ADL (decline in self-care ADL function) Trajectory c: Patients acquiring new or additional disability in self-care ADL between baseline and admission who did not recover to baseline function by the time of hospital discharge Trajectory d: Patients who did not decline in self-care ADL function between baseline and admission but acquired new or additional disability in self-care ADL between admission and discharge.

Figure 2

Course of self-care Activities of Daily Living (ADL) Outcomes and Survival after Hospitalization Footnotes: Discharged at baseline function: N=1480 Discharged with new or additional disability in self-care ADL: N=799 Baseline: at baseline level of self-care ADL function Decline: with more self-care ADL disabilities compared to baseline level of self-care ADL function

Figure 3

Among those discharged with new or additional disability in self-care ADL, recovery to baseline level of self-care Activities of Daily Living by 1 month after discharge (N=651): Association with outcomes over 1 year Footnotes: N=651 Of the original sample of those discharged with new or additional disability in self-care ADL (N=799), participants who were alive at discharge but who had died (n=108) or who had missing data at 1 month (n=40) were excluded. Baseline: recovery to baseline level of self-care Activities of Daily Living (ADL) function Decline: more self-care ADL disabilities compared to baseline level of self-care ADL function