Trajectories of life-space mobility after hospitalization

Abstract

Background: Life space is a measure of where a person goes, the frequency of going there, and the dependency in getting there. It may be a more accurate measure of mobility in older adults because it reflects participation in society as well as physical ability.

Objective: To assess effects of hospitalization on life space in older adults, and to compare life-space trajectories associated with surgical and nonsurgical hospitalizations.

Design: Prospective observational study.

Setting: Central Alabama.

Participants: 687 community-dwelling Medicare beneficiaries at least 65 years of age with surgical (n = 44), nonsurgical (n = 167), or no (n = 476) hospitalizations.

Measurements: Life-Space Assessment (LSA) scores before and after hospitalization (range, 0 to 120; higher scores reflect greater mobility).

Results: Mean age of participants was 74.6 years (SD, 6.3). Fifty percent were black, and 46% were male. Before hospitalization, adjusted LSA scores were similar in participants with surgical and nonsurgical admissions. Life-space assessment scores decreased in both groups immediately after hospitalization; however, participants with surgical hospitalizations had a greater decrease in scores (12.1 more points [95% CI, 3.6 to 20.7 points]; P = 0.005) than those with nonsurgical hospitalizations. However, participants with surgical hospitalizations recovered more rapidly over time (gain of 4.7 more points [CI, 2.0 to 7.4 points] per ln [week after discharge]; P < 0.001). Score recovery for participants with nonsurgical hospitalizations did not significantly differ from the null (average recovery, 0.7 points [CI, -0.6 to 1.9 points] per ln [week after discharge]).

Limitation: Life space immediately before and after hospitalization was self-reported, often after hospital discharge.

Conclusion: Hospitalization decreases life space in older adults. Surgical hospitalizations are associated with immediate marked life-space declines followed by rapid recovery, in contrast to nonsurgical hospitalizations, which are associated with more modest immediate declines and little evidence of recovery after several years of follow-up.

Primary funding source: National Institute on Aging.

Figure 1. Flow of potential participants

This figure shows the number of participants who were alive and participated through the four years of follow-up and that did or did not have an overnight hospitalization from the 6-month to the 48-month interview.

Figure 2. Trajectory of Adjusted Life-Space Mobility Decline and Recovery: Surgical Admissions Compared to Non-surgical Admissions

This figure shows the estimated trajectories of life-space mobility based on reason for admission after adjusting for covariates including age, gender, race, rural/urban status, comorbidities and ADL independence. Life-space mobility trajectories of participants hospitalized with a major surgical and non-surgical admission are shown in green and blue, respectively. For patients with a hospitalization, the calendar time for a hospitalization was centered at the median time to a first hospital admission (1.95 [IQR = 2.28]).