Use of an ambulation assistive device predicts functional decline associated with hospitalization.
BACKGROUND
Loss of functional independence occurs frequently with hospitalization. In community-dwelling elders, lower extremity disability is an important predictor of functional loss. Ambulation assistive devices (canes, walkers), as markers of lower extremity disability, may predict functional decline associated with hospitalization, but this has not been evaluated previously. We sought to determine the association of mobility impairment, as indicated by cane or walker use prehospitalization, with adverse outcomes at hospital discharge and 3 months post discharge.


METHODS
Subjects were community-dwelling adults (N = 1212) aged 70 and older, hospitalized for acute medical illness. The study was a secondary analysis of the Hospital Outcomes Project for the Elderly, a prospective randomized trial at three university and two private acute-care hospitals, which randomized patients to usual care or an intervention group designed to maintain functional abilities.


RESULTS
After controlling for demographic and illness-related characteristics and prehospital function, mobility impairment was significantly associated with functional decline. Use of a walker was associated with 2.8 times increased risk for decline in ADL function by hospital discharge (p = .0002). Three months after discharge, patients who used assistive devices prior to hospitalization were more likely to have declined in both ADLs (p = .02) and IADLs (p = .003).


CONCLUSIONS
Hospitalized patients with mobility impairment, as indicated by use of a cane or a walker, are at high risk for functional decline. Such patients may benefit from more intensive in-hospital and post-hospital rehabilitative therapy to maintain function.
Geriatric Research, Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA. jemahone@facstaff.wisc.edu
J E
JE
Mahoney
M A
MA
Sager
M
M
Jalaluddin
D000203:Activities of Daily Living; D000368:Aged; D002183:Canes; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006760:Hospitalization; D006801:Humans; D008297:Male; D009069:Movement Disorders / Q000534:rehabilitation; D009983:Orthopedic Equipment; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D011446:Prospective Studies; D012307:Risk Factors; D012656:Self-Help Devices; D014853:Walkers; D016138:Walking / Q000502:physiology*