title: Assessment of pneumonia in older adults: effect of functional status.
abstract: OBJECTIVE
  Evaluate the effect of preadmission functional status on severity of pneumonia, length of hospital stay (LOS), and all-cause 30-day and 1-year mortality of adults aged 60 and older and to understand the effect of pneumonia on short-term functional impairment.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  One hundred twelve patients with radiograph-proven pneumonia (mean age 74.6) were enrolled.
  
  
  METHODS
  Functional status and comorbidities were assessed using the Functional Autonomy Measurement System (SMAF) and Charlson Comorbidity Index. Clinical information was used to calculate the Pneumonia Prognostic Index (PPI).
  
  
  RESULTS
  Eighty-four (75%) patients were functionally independent (FI) before admission, with a SMAF score of 40 or lower. Dementia and aspiration history were higher in the group that was functionally dependent (FD) before admission (P<.001). The FI group had less-severe pneumonia per the PPI and shorter mean LOS+/-standard deviation (5.62+/-0.51 days) than the FD group (11.42+/-2.58, P<.004). The FI group had lower 1-year mortality (19/65, 23%) than the FD group (14/28, 50%), and the difference remained significant after adjusting for Charlson Index and severity of illness (P=.009). All patients lost function after admission, with loss being more pronounced in the FI group (mean change 19.24+/-12.9 vs 4.72+/-6.55, P<.001).
  
  
  CONCLUSIONS
  Older adults who were FI before admission were more likely to present with less-severe pneumonia and have a shorter LOS. In addition, further loss of function was common in these patients. Assessment of function before and during hospitalization should be an integral part of clinical evaluation in all older adults with pneumonia.
authors.affiliation: Division of Geriatric Medicine, Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan 48105, USA. lonamody@umich.edu
authors.forename: Lona
authors.initials: L
authors.lastname: Mody
authors.forename: Rongjun
authors.initials: R
authors.lastname: Sun
authors.forename: Suzanne F
authors.initials: SF
authors.lastname: Bradley
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D015577:Geriatric Assessment; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D016017:Odds Ratio; D011014:Pneumonia / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000401:mortality; D011446:Prospective Studies; D011859:Radiography