A prospective pilot study to measure changes in functional status associated with hospitalization in elderly dialysis-dependent patients.
BACKGROUND
Older dialysis patients have a high burden of mortality and morbidity. Frailty and functional disability are common. One of the main determinants of functional disability in nondialysis populations is acute hospitalization. Such episodes are predictive of increased mortality and a future need for long-term care. Based on the high prevalence of disability in the dialysis population, we undertook a pilot study to determine functional impairment at the time of admission and again at 1 week after discharge.


METHODS
Prospective cohort study.


METHODS
Prevalent dialysis patients older than 65 years admitted to a single acute-care institution during a 3-month period.


RESULTS
The proportion of dialysis patients with difficulty with activities of daily living at baseline and 1 week after discharge.


METHODS
Basic activities of daily living; Lawton Brody Instrumental Activities of Daily Living score; timed up-and-go and handgrip tests; Trails A & B, and the clock test.


RESULTS
At the time of admission, only 8 of 35 individuals reported being independent with basic activities of daily living. None of the patients was independent with instrumental activities of daily living. At 1 week after discharge, patients showed deterioration in all aspects of function except the ability to use the telephone and manage their financial affairs. A total of 73.3% of patients (95% confidence interval, 54.1 to 87.7) experienced a decline in personal functional independence in association with hospitalization.


CONCLUSIONS
This is a pilot study with a small number of patients who were studied at only 2 times (admission and 1 week after discharge).


CONCLUSIONS
Results of this study suggest that hospitalization is associated with a high rate of disability in elderly dialysis patients. Further study is required to determine whether the functional deterioration seen with hospitalization improves over time.
Department of Physiatry and Kinesiology, University of Western Ontario, Toronto, Ontario, Canada.
Derek
D
Lo
Ernest
E
Chiu
Sarbjit V
SV
Jassal
D000203:Activities of Daily Living; D000368:Aged; D005260:Female; D016330:Frail Elderly; D006760:Hospitalization; D006801:Humans; D008297:Male; D010865:Pilot Projects; D011446:Prospective Studies; D006435:Renal Dialysis