title: A clinical index to stratify hospitalized older adults according to risk for new-onset disability.
abstract: BACKGROUND
  Many older adults who are independent prior to hospitalization develop a new disability by hospital discharge. Early risk stratification for new-onset disability may improve care. Thus, this study's objective was to develop and validate a clinical index to determine, at admission, risk for new-onset disability among older, hospitalized adults at discharge.
  
  
  METHODS
  Data analyses derived from two prospective studies.
  
  
  METHODS
  Two teaching hospitals in Ohio.
  
  
  METHODS
  Eight hundred eighty-five patients aged 70 years and older were discharged from a general medical service at a tertiary care hospital (mean age 78, 59% female) and 753 patients discharged from a separate community teaching hospital (mean age 79, 63% female). All participants reported being independent in five activities of daily living (ADLs: bathing, dressing, transferring, toileting, and eating) 2 weeks before admission.
  
  
  METHODS
  New-onset disability, defined as a new need for personal assistance in one or more ADLs at discharge in participants who were independent 2 weeks before hospital admission.
  
  
  RESULTS
  Seven independent risk factors known on admission were identified and weighted using logistic regression: age (80-89, 1 point; ≥90, 2 points); dependence in three or more instrumental ADLs at baseline (2 points); impaired mobility at baseline (unable to run, 1 point; unable to climb stairs, 2 points); dependence in ADLs at admission (2-3 ADLs, 1 point; 4-5 ADLs, 3 points); acute stroke or metastatic cancer (2 points); severe cognitive impairment (1 point); and albumin less than 3.0 g/dL (2 points). New-onset disability occurred in 6%, 13%, 18%, 34%, 35%, 45%, 50%, and 87% of participants with 0, 1, 2, 3, 4, 5, 6, and 7 or more points, respectively, in the derivation cohort (area under the receiver operating characteristic curve (AUC)=0.784), and in 8%, 10%, 27%, 38%, 44%, 45%, 58%, and 83%, respectively, in the validation cohort (AUC=0.784). The risk score also predicted (P<.001) disability severity, nursing home placement, and long-term survival.
  
  
  CONCLUSIONS
  This clinical index determines risk for new-onset disability in hospitalized older adults and may inform clinical care.
authors.affiliation: Division of Geriatrics, University of California at San Francisco, San Francisco, CA 94121, USA. Kala.mehta@ucsf.edu
authors.forename: Kala M
authors.initials: KM
authors.lastname: Mehta
authors.forename: Edgar
authors.initials: E
authors.lastname: Pierluissi
authors.forename: W John
authors.initials: WJ
authors.lastname: Boscardin
authors.forename: Katharine A
authors.initials: KA
authors.lastname: Kirby
authors.forename: Louise C
authors.initials: LC
authors.lastname: Walter
authors.forename: Mary-Margaret
authors.initials: MM
authors.lastname: Chren
authors.forename: Robert M
authors.initials: RM
authors.lastname: Palmer
authors.forename: Steven R
authors.initials: SR
authors.lastname: Counsell
authors.forename: C Seth
authors.initials: CS
authors.lastname: Landefeld
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000150:complications; D005260:Female; D006760:Hospitalization; D006801:Humans; D007297:Inpatients / Q000145:classification*; D016015:Logistic Models; D008297:Male; D051346:Mobility Limitation; D009369:Neoplasms / Q000150:complications; D010343:Patient Admission; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications