title: [Predictors of functional decline of older persons after an hospitalisation in an acute care for elder unit: importance of recent functional evolution].
abstract: OBJECTIVE
  To identify the predictors of functional decline of older persons after hospitalization in an Acute Care for Elder unit (ACE).
  
  
  METHODS
  Retrospective observational study based on a population hospitalised in ACE unit in Grenoble University Hospital. Dead patients within hospitalisation and patient fully disable or already hospitalized 15 days before hospitalisation were excluded. The primary outcome was the functional decline defined by a loss in activity daily life (ADL) between discharge and 15 days before hospitalisation. The predictive factors included socio-demographic data, geriatric assessment and the admission pathway.
  
  
  RESULTS
  184 patients were included (mean 86.4±6.2 years, 64.1% women). The admission by emergency department was predominant (77.2%). The mean length of stay was 16.0±9.5 days. A functional decline as present for 31.0% des patients; for 95% of these patients, the functional decline occurred before admission to ACE. Factors associated with functional decline at discharge were: recent functional decline, ADL level at admission, pressure sore, denutrition and admission via the emergency room (ER) (p<0.05). In the multivariate analysis, recent functional decline was strongly associated with functional decline at discharge (OR=58.8, p<0.01). Outside this factor, ADL level at admission (OR=3.2, p<0.01), hypoalbuminemaia (OR=2.6, p=0.01) and an admission via the ER (OR=2.6, p=0.05) were independently associated with functional decline at discharge.
  
  
  CONCLUSIONS
  Better management of hospitalised older persons, according to the ACE model, has diminished the negative functional effects of hospitalization. Identification of recent functional decline rather than other usually identified predictors would be useful for detection of older patients who might benefit from a geriatric program. Detecting and correcting early malnutrition and developing direct admissions mechanisms may improve functional prognosis of hospitalised older patients.
authors.affiliation: CHU de Grenoble, clinique universitaire de médecine gériatrique, 38043 Grenoble cedex 09, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Mazière
authors.forename: Isabelle
authors.initials: I
authors.lastname: Lanièce
authors.forename: Nassira
authors.initials: N
authors.lastname: Hadri
authors.forename: Catherine
authors.initials: C
authors.lastname: Bioteau
authors.forename: Claire
authors.initials: C
authors.lastname: Millet
authors.forename: Pascal
authors.initials: P
authors.lastname: Couturier
authors.forename: Gaëtan
authors.initials: G
authors.lastname: Gavazzi
mesh_terms: D000203:Activities of Daily Living; D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005544:Forecasting; D005853:Geriatrics; D006757:Hospital Units; D006760:Hospitalization; D006801:Humans; D008297:Male; D012189:Retrospective Studies