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Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit
Published on: September 30, 2020
Acute functional decline before hospitalization in older patients
Lorenzo Palleschi1, Filippo Luca Fimognari, Andrea Pierantozzi
1Unit of Geriatrics, Azienda Ospedaliera S. Giovanni-Addolorata, Rome, Italy.
Functional decline before hospitalization is common in older adults, particularly those with dementia or pulmonary disease. Low preadmission function and older age are key predictors of this prehospital decline.
Area of Science:
- Geriatric Medicine
- Internal Medicine
- Public Health
Background:
- Acute diseases and hospitalizations significantly impact the functional decline of elderly individuals.
- Much of this functional decline in vulnerable patients occurs in the days leading up to hospitalization due to acute illnesses.
Purpose of the Study:
- To identify the key determinants of prehospital functional decline in elderly patients admitted for acute illnesses.
Main Methods:
- A prospective observational study involving 1281 patients aged 65+ admitted to acute geriatric and general medicine units.
- Functional status was assessed using the Barthel Index at two weeks preadmission and upon hospital admission.
- The percentage extent of prehospital decline (PEPD) was calculated for patients exhibiting decline.
Main Results:
- Prehospital decline was observed in 42.2% of patients, predominantly those hospitalized in geriatric wards.
- Older age (OR 1.06) and dementia (OR 2.8) were significant predictors of prehospital decline; higher preadmission function was protective (OR 0.992).
- Pulmonary disease was associated with prehospital decline (OR 1.8); lower preadmission function and emergency room origin predicted larger PEPD.
Conclusions:
- Disease-related prehospital disability is a significant issue in elderly populations.
- Key factors contributing to prehospital decline include low preadmission function, advanced age, and the presence of dementia.
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