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Published on: March 27, 2018
Course of functional status in elderly patients after coronary artery bypass surgery: 6-month follow up
Márcio Niemeyer-Guimarães1,2, Maysa Seabra Cendoroglo3, Clineu Mello Almada-Filho3
1Intensive Care Unit, Hospital Federal dos Servidores do Estado, Brazilian Ministry of Health, Rio de Janeiro, Brazil.
Insights
The Functional Independence Measure effectively tracks functional decline in elderly patients after coronary artery bypass grafting. This assessment tool shows promise for monitoring recovery, particularly in those over 70.
Area of Science:
- Geriatric Medicine
- Cardiovascular Surgery
- Rehabilitation Science
Background:
- Elderly patients undergoing coronary artery bypass grafting (CABG) face risks of functional decline.
- Assessing functional status longitudinally is crucial for effective rehabilitation post-cardiac surgery.
- Existing functional assessment scales may vary in their sensitivity to detect changes in this population.
Purpose of the Study:
- To evaluate longitudinal changes in functional status among elderly patients post-CABG.
- To compare the efficacy of three functional assessment scales: Functional Independence Measure (FIM), Katz Activities of Daily Living (ADL) scale, and Lawton Instrumental Activities of Daily Living (IADL) scale.
- To identify the most sensitive scale for detecting functional recovery in this patient group.
Main Methods:
- A prospective observational cohort study involving 73 patients aged 60 years and older undergoing elective CABG.
- Functional status was assessed pre-admission, at discharge, and at 1 and 6 months post-discharge using FIM, Katz ADL, and Lawton IADL scales.
- Data were stratified by age (≥70 vs. <70 years) and presence of complications for comparative analysis.
Main Results:
- The Functional Independence Measure (FIM) detected significant functional loss over 6 months in elderly patients post-CABG (P < 0.001).
- Older patients (≥70 years) showed a trend towards functional recovery over time as measured by FIM scores compared to their pre-admission baseline.
- No significant changes in scale scores were observed over time between patients with and without complications.
Conclusions:
- The Functional Independence Measure (FIM) is a sensitive tool for assessing functional status changes in elderly patients following coronary artery bypass grafting.
- FIM demonstrates potential for monitoring functional recovery in the medium term (up to 6 months) after cardiac surgery.
- The FIM scale appears particularly valuable for assessing functional recovery in patients aged over 70 years post-CABG.
Aim:
To determine longitudinal changes in functional status using three functional assessment scales in elderly patients undergoing coronary artery bypass grafting.
Methods:
This was a prospective observational cohort study of 73 patients aged ≥60 years undergoing elective coronary artery bypass grafting. Patients were assessed for functional status before admission, at hospital discharge, and at 1 and 6 months after discharge using the Functional Independence Measure, Katz Activities of Daily Living scale, and Lawton Instrumental Activities of Daily Living scale. Data were stratified by age (≥70 years and <70 years) and complications (with and without) for analysis.
Results:
In patients aged ≥70 years (n = 38), Functional Independence Measure scores ranged from 121.30 ± 6.42 (pre-admission) to 112.10 ± 17.10 (1 month) and 117.80 ± 13.50 (6 months), Katz scores from 5.88 ± 0.32 (pre-admission) to 5.45 ± 1.04 (1 month) and 5.83 ± 0.65 (6 months), and Lawton scores from 25.40 ± 3.30 (pre-admission) to 20.05 ± 4.93 (1 month) and 24.50 ± 4.10 (6 months; P < 0.001 for all). No significant changes were found in scale scores over time between groups with (n = 34) and without (n = 39) complications. When groups aged ≥70 years (n = 38) and <70 (n = 35) were compared, Functional Independence Measure scores showed a difference toward recovery over time in older patients (discharge - pre-admission, P = 0.010; 1 month - pre-admission, P = 0.0004; and 6 months - pre-admission, P = 0.079).
Conclusions:
The Functional Independence Measure was able to detect significant functional loss over a 6-month period in elderly patients undergoing coronary artery bypass grafting, suggesting that this scale is a promising tool for the assessment of functional recovery over time after cardiac surgery, especially in patients aged older than 70 years. Geriatr Gerontol Int 2015; ●●: ●●-●●.
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