Gill TM, Allore HG, Holford TR, et al. Hospitalization, restricted activity, and the development of disability among older persons

Department of Internal Medicine, Yale University School of Medicine, Dorothy Adler Geriatric Assessment Center, New Haven, Conn 06504, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 12/2004; 292(17):2115-24. DOI: 10.1001/jama.292.17.2115
Source: PubMed


Preventing the development of disability in activities of daily living is an important goal in older adults, yet relatively little is known about the disabling process.
To evaluate the relationship between 2 types of intervening events (hospitalization and restricted activity) and the development of disability and to determine whether this relationship is modified by the presence of physical frailty.
Prospective cohort study, conducted in the general community in greater New Haven, Conn, from March 1998 to March 2003, of 754 persons aged 70 years or older, who were not disabled (ie, required no personal assistance) in 4 essential activities of daily living: bathing, dressing, walking inside the house, and transferring from a chair. Participants were categorized into 2 groups according to the presence of physical frailty (defined on the basis of slow gait speed) and were followed up with monthly telephone interviews for up to 5 years to ascertain exposure to intervening events and determine the occurrence of disability.
Disability, defined as the need for personal assistance in bathing, dressing, walking inside the house, or transferring from a chair.
During the 5-year follow-up period, disability developed among 417 (55.3%) participants, 372 (49.3%) were hospitalized and 600 (79.6%) had at least 1 episode of restricted activity. The multivariable hazard ratios for the development of disability were 61.8 (95% confidence interval [CI], 49.0-78.0) within a month of hospitalization and 5.54 (95% CI, 4.27-7.19) within a month of restricted activity. Strong associations were observed for participants who were physically frail and those who were not physically frail. Hospital admissions for falls were most likely to lead to disability. Intervening events occurring more than a month prior to disability onset were not associated with the development of disability. The population-attributable fractions associated with new exposure to hospitalization and restricted activity, respectively, were 0.48 and 0.19; 0.40 and 0.20, respectively, for frail participants and 0.61 and 0.16, respectively, for nonfrail participants.
Illnesses and injuries leading to either hospitalization or restricted activity represent important sources of disability for older persons living in the community, regardless of the presence of physical frailty. These intervening events may be suitable targets for the prevention of disability.

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    • "Falls and fall-related injuries and inability of correct walking are some of the main clinical problems due to the associated mortality, morbidity, and cost of those burden patients, their families and society as a whole (Melton et al., 1999; Gill et al., 2004; Kannus et al., 2005). Due to the rapid increase in the elderly population and low levels of physical activity, falls and incorrect walking are increasingly common among the elderly (Montoye, 2000; Gonzalez et al., 2001). "
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    • "Rehabilitating neck of femur patients and reducing inpatient stay are also of importance. Previous studies have shown early surgery results in better mobilisation postoperatively, and this should translate into earlier discharge [13, 14]. Siu et al. showed that bed rest led to a deleterious effect on muscle quality, and showed a one-point difference in the motor scale of the functional independence measure [15]. "
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    • "Seven established risk factors of functional disability were considered as predictors of ADL trajectory [11e15], including older age (!85 years), female gender, living alone, frailty as defined by slow gait [12] [13], depression as defined by a score of 20 or higher on the short-form of the Center for Epidemiologic Studies-Depression scale [16], cognitive impairment as defined by a score of less than 24 on the Mini-Mental State Examination [17] and having two or more chronic conditions. These factors were measured during the comprehensive, in-home assessments at baseline and then approximately every 18 months. "
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