Characteristics of nondisabled older patients developing new disability associated with medical illnesses and hospitalization.
OBJECTIVE
To identify demographic, clinical, and biological characteristics of older nondisabled patients who develop new disability in basic activities of daily living (BADL) during medical illnesses requiring hospitalization.


METHODS
Longitudinal observational study.


METHODS
Geriatric and Internal Medicine acute care units.


METHODS
Data are from 1,686 patients aged 65 and older who independent in BADL 2 weeks before hospital admission, enrolled in the 1998 survey of the Italian Group of Pharmacoepidemiology in the Elderly Study.


METHODS
Study outcome was new BADL disability at time of hospital discharge. Sociodemographic, functional status, and clinical characteristics were collected at hospital admission; acute and chronic conditions were classified according to the International Classification of Disease, ninth revision; fasting blood samples were obtained and processed with standard methods.


RESULTS
At the time of hospital discharge 113 patients (6.7%) presented new BADL disability. Functional decline was strongly related to patients' age and preadmission instrumental activities of daily living status. In a multivariate analysis, older age, nursing home residency, low body mass index, elevated erythrocyte sedimentation rate, acute stroke, high level of comorbidity expressed as Cumulative Illness Rating Scale score, polypharmacotherapy, cognitive decline, and history of fall in the previous year were independent and significant predictors of BADL disability.


CONCLUSIONS
Several factors might contribute to loss of physical independence in hospitalized older persons. Preexisting conditions associated with the frailty syndrome, including physical and cognitive function, comorbidity, body composition, and inflammatory markers, characterize patients at high risk of functional decline.
Volpato
Stefano
S
Department of Clinical and Experimental Medicine, Section of Internal Medicine, Gerontology, and Geriatrics, University of Ferrara, Ferrara, Italy. vlt@unife.it
Onder
Graziano
G
Cavalieri
Margherita
M
Guerra
Gianluca
G
Sioulis
Fotini
F
Maraldi
Cinzia
C
Zuliani
Giovanni
G
Fellin
Renato
R
D000203:Activities of Daily Living / Q000523:psychology; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000150:complications / Q000453:epidemiology / Q000523:psychology; D006233:Persons with Disabilities / Q000523:psychology; D005260:Female; D016330:Frail Elderly / Q000523:psychology; D006760:Hospitalization; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010351:Patient Discharge; D012307:Risk Factors