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Loss of independence in Katz’s ADL ability in connection with an acute hospitalization: early clinical markers in French older people

  • Pierre-Olivier Lang
  • Nicolas Meyer
  • Damien Heitz
  • Moustapha Dramé
  • Nicolas Jovenin
  • Joël Ankri
  • Dominique Somme
  • Jean-Luc Novella
  • Jean-Bernard Gauvain
  • Pascal Couturier
  • Isabelle Lanièce
  • Thierry Voisin
  • Benoit de Wazières
  • Régis Gonthier
  • Claude Jeandel
  • Damien Jolly
  • Olivier Saint-Jean
  • François Blanchard
Geriatric Epidemiology

Abstract

Background

The preservation of autonomy and the ability of elderly to carry out the basic activities of daily living, beyond the therapeutic care of any pathologies, appears as one of the main objectives of care during hospitalization.

Objectives

To identify early clinical markers associated with the loss of independence in elderly people in short stay hospitals.

Methods

Among the 1,306 subjects making up the prospective and multicenter SAFEs cohort study (Sujet Agé Fragile: Évolution et suivi—Frail elderly subjects, evaluation and follow-up), 619 medical inpatients, not disabled at baseline and hospitalized through an emergency department were considered. Data used in a multinomial logistic regression were obtained through a comprehensive geriatric assessment (CGA) conducted in the first week of hospitalization. Dependency levels were assessed at baseline, at inclusion and at 30 days using Katz’s ADL index. Baseline was defined as the dependence level before occurrence of the event motivating hospitalization. To limit the influence of rehabilitation on the level of dependence, only stays shorter than 30 days were considered.

Results

About 514 patients were eligible, 15 died and 90 were still hospitalized at end point (n = 619). Two-thirds of subjects were women, with a mean age of 83. At day 30 162 patients (31%) were not disabled; 61 (12%) were moderately disabled and 291 severely disabled (57%). No socio-demographic variables seemed to influence the day 30 dependence level. Lack of autonomy (odds ratio (OR) = 1.9, 95% confidence interval (CI) = 1.2–3.6), walking difficulties (OR = 2.7, 95% CI = 1.3–5.6), fall risk (OR = 2.1, 95% CI = 1.3–6.8) and malnutrition risk (OR = 2.2, 95% CI = 1.5–7.6) were found in multifactorial analysis to be clinical markers for loss of independence.

Conclusions

Beyond considerations on the designing of preventive policies targeting the populations at risk that have been identified here, the identification of functional factors (lack of autonomy, walking difficulties, risk of falling) suggests above all that consideration needs to be given to the organization per se of the French geriatric hospital care system, and in particular to the relevance of maintaining sector-type segregation between wards for care of acute care and those involved in rehabilitation

Keywords

Loss of independence Katz’s ADL abilities Frail elderly people SAFEs cohort 

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Copyright information

© Springer Science+Business Media B.V. 2007

Authors and Affiliations

  • Pierre-Olivier Lang
    • 1
    • 2
  • Nicolas Meyer
    • 3
  • Damien Heitz
    • 4
  • Moustapha Dramé
    • 2
    • 5
  • Nicolas Jovenin
    • 2
    • 6
  • Joël Ankri
    • 7
  • Dominique Somme
    • 2
    • 8
  • Jean-Luc Novella
    • 2
    • 5
  • Jean-Bernard Gauvain
    • 9
  • Pascal Couturier
    • 10
  • Isabelle Lanièce
    • 10
  • Thierry Voisin
    • 11
  • Benoit de Wazières
    • 12
  • Régis Gonthier
    • 13
  • Claude Jeandel
    • 14
  • Damien Jolly
    • 2
    • 6
  • Olivier Saint-Jean
    • 8
  • François Blanchard
    • 2
    • 5
  1. 1.Department of Rehabilitation and Geriatrics, Hospital of Trois-ChêneUniversity Hospitals of GenevaGenevaSwitzerland
  2. 2.University of Reims Champagne-Ardenne, School of MédecineReimsFrance
  3. 3.Department of Public HealthUniversity Hospitals of StrasbourgStrasbourgFrance
  4. 4.Department of GeriatricsUniversity Hospitals of StrasbourgStrasbourgFrance
  5. 5.Department of GerontologyUniversity Hospitals of ReimsReimsFrance
  6. 6.Clinical Research UnitUniversity Hospitals of ReimsReimsFrance
  7. 7.Center of Gerontology, Hospital Sainte PerrineAssistance Publique Hôpitaux de ParisParisFrance
  8. 8.Geriatrics Unit, European Hospital Georges PompidouAssistance Publique Hôpitaux de ParisParisFrance
  9. 9.Center of Geriatrics Medicine, Hospital Porte MadeleineGeneral Hospital Center of OrleansOrleansFrance
  10. 10.Geriatrics ClinicUniversity Hospitals of GrenobleGrenobleFrance
  11. 11.Geriatrics and Gerontology CenterUniversity Hospitals of ToulouseToulouseFrance
  12. 12.Geriatrics unitUniversity Hospitals of NimesNimesFrance
  13. 13.Clinical gerontology unitUniversity Hospital of Saint EtienneSaint EtienneFrance
  14. 14.Center of clinical gerontologyUniversity Hospitals of MontpellierMontpellierFrance

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