Recovery of activities of daily living in older adults after hospitalization for acute medical illness.
OBJECTIVE
To compare functional outcomes in the year after discharge for older adults discharged from the hospital after an acute medical illness with a new or additional disability in their basic self-care activities of daily living (ADL) (compared with preadmission baseline 2 weeks before admission) with those of older adults discharged with baseline ADL function and identify predictors of failure to recover to baseline function 1 year after discharge.


METHODS
Observational.


METHODS
Tertiary care hospital, community teaching hospital.


METHODS
Older (aged >or=70) patients nonelectively admitted to general medical services (1993-1998).


METHODS
Number of ADL disabilities at preadmission baseline and 1, 3, 6, and 12 months after discharge. Outcomes were death, sustained decline in ADL function, and recovery to baseline ADL function at each time point.


RESULTS
By 12 months after discharge, of those discharged with new or additional ADL disability, 41.3% died, 28.6% were alive but had not recovered to baseline function, and 30.1% were at baseline function. Of those discharged at baseline function, 17.8% died, 15.2% were alive but with worse than baseline function, and 67% were at their baseline function (P<.001). Of those discharged with new or additional ADL disability, the presence or absence of recovery by 1 month was associated with long-term outcomes. Age, cardiovascular disease, dementia, cancer, low albumin, and greater number of dependencies in instrumental ADLs independently predicted failure to recover.


CONCLUSIONS
For older adults discharged with new or additional disability in ADL after hospitalization for medical illness, prognosis for functional recovery is poor. Rehabilitation interventions of longer duration and timing than current reimbursement allows, caregiver support, and palliative care should be evaluated.
Boyd
Cynthia M
CM
Department of Medicine, Division of Geriatric Medicine, School of Medicine, John Hopkins University, Baltimore, Maryland 21224, USA. cboyd1@jhmi.edu
Landefeld
C Seth
CS
Counsell
Steven R
SR
Palmer
Robert M
RM
Fortinsky
Richard H
RH
Kresevic
Denise
D
Burant
Christopher
C
Covinsky
Kenneth E
KE
D000203:Activities of Daily Living; D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D010351:Patient Discharge; D020127:Recovery of Function; D013997:Time Factors