[Functional decline during hospitalization in elderly patients. Benefits of admission to the geriatrics service]

In some elderly individuals, hospital admission for acute illness represents a possible loss of autonomy not always related to the reason for hospitalization. The importance of this problem and the possible existence of differences among services are not sufficiently well known.

To compare the incidence of functional decline and associated risk factors during hospitalization between an acute care geriatric unit (GU) and an internal medicine (IM) ward.

We performed a prospective, cohort study. Sociodemographic characteristics, comorbidity, cause of admission, severity, use of several hospital practices, mortality rate and functional decline were analyzed. Functional decline was defined as the loss of independence to perform at least one of the basic activities of daily living with respect to preadmission status. The influence of the admitting service was evaluated by a multiple logistic regression model.

A total of 379 patients were included (140 in the GU and 239 in IM). Compared with IM, patients in the GU were older (87 vs 81.5; P< .001), had a greater prevalence of dementia and visual alterations and worse previous functional status. The proportion of patients who spent > 48 hours in bed and who received nocturnal medication was lower in the GU. The functional decline rate was greater in IM than in the GU (60.2% vs 48%; P=.04). Length of hospital stay was similar in both groups (7.7 vs 8.1 days; P=.37). Functional decline was associated with age, delirium, lack of mobilization, bed rest for > 48 h, psychotropic drugs, nocturnal medication and physical restraints. In the multivariate analysis, admission to IM was associated with a greater risk of functional decline.

Functional decline during hospitalization for acute diseases is frequent among frail patients. Many modifiable clinical practices are associated with this complication. In patients at risk of delirium, admission to geriatric wards may be associated with less functional deterioration than admission to internal medicine wards.