Loss of independence in Katz’s ADL ability in connection with an acute hospitalization: early clinical markers in French older people
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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.
To identify early clinical markers associated with the loss of independence in elderly people in short stay hospitals.
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.
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.
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
KeywordsLoss of independence Katz’s ADL abilities Frail elderly people SAFEs cohort
- 1.Fried LP, Ferrucci L, Darer J, et al. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting care. J Gerontol A Biol Sci Med 2004;59:M255–63.Google Scholar
- 3.National Institutes of Health Consensus Development Conference Statement: Geriatrics assessment methods for clinical decision-making. J Am Geriatr Soc 1988;36:342–7.Google Scholar
- 5.Wu AW, Yasui Y, Alzola C, et al. Predicting functional status outcomes in hospitalized patients aged 80 years and older. J Am Geriatr Soc 2000;48:6–15.Google Scholar
- 16.Fillenbaum GC. Functional ability. In: Ebrahim S, Kalache A, editors. Epidemiology in old age. London: BMJ Publishing Group; 1996.p. 228–235.Google Scholar
- 18.Gilleard CJ, Willmott M, Viddadi KS. Self-report measures of mood and morale in elderly depressive. Br J Psychiat 1981;138:230–5.Google Scholar
- 21.Podsialdo D, Richardson S. The timed “Get up & Go”: a test for basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991;39:142–8.Google Scholar
- 25.Norton D, Mclaren R, Exton-Smith AN. An Investigation of Nursing Problems in Hospitals. New York: Churchill Livingstone, 1975.Google Scholar
- 28.Armitage P, Berry G, Matthews JNS. Statistical Methods in Medical research: Oxford, England: Blackwell Scientific, 2002.Google Scholar
- 29.Hosner DW, Lemeshow S. Applied logistic regression. New-York: John Wiley & Sons; 1989.Google Scholar
- 34.Jeandel C, Pfitzenmeyer P, Vigouroux P. Un programme pour la gériatrie : 5 objectifs, 20 recommandations, 45 mesures pour atténuer l’impact du choc démographique sur le fonctionnement des hôpitaux dans les 15 ans à venir. Paris: Ministère de la sécurité sociale, des personnes âgées, des personnes handicapées et de la famille, République Française., 2006.Google Scholar
- 35.Landi F, Onder G, Cesari M, et al. Psychotropic medications and risk for falls among community-dwelling frail older people: an observational study. J Gerontol A Biol Sci Med 2005;60:622–6.Google Scholar
- 40.Belmin J. Assessing nutritional status in elderly: a different approach from assessing general health status. Press Med 2000;29:2169–70.Google Scholar
- 42.Fillol C, Ittah-Desmeulles H, Bourdillon F, et al. Durée de séjour et orientation des personnes hospitalisées âgées de 80 ans et plus dans un CHU parisien. Rev de Gériatrie 2006;31:405–13.Google Scholar
- 44.Vetel JM, Lussier MD, Clément JP, et al. Commentaires à propos de la tarification à l’activité en court séjour gériatrique. Rev de Gériatrie 2005;30:238–40.Google Scholar
- 45.Saint-Jean O, Lahjibi-Paullet H, Somme D. Tarification à l’activité et court séjour gériatrique. Rev de Gériatrie 2004;29:687–92.Google Scholar