title: Hospital-associated functional decline: the role of hospitalization processes beyond individual risk factors.
abstract: OBJECTIVE
  To investigate the combined contribution of processes of hospitalization and preadmission individual risk factors in explaining functional decline at discharge and at 1-month follow-up in older adults with nondisabling conditions.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Internal medicine wards in two Israeli medical centers.
  
  
  METHODS
  Six hundred eighty-four individuals aged 70 and older admitted for a nondisabling problem.
  
  
  METHODS
  Functional decline was measured according to change in modified Barthel Index from premorbid to discharge and from premorbid to 1 month after discharge. In-hospital mobility, continence care, sleep medication consumption, satisfaction with hospital environment, and nutrition intake were assessed using previously tested self-report instruments.
  
  
  RESULTS
  Two hundred eighty-two participants (41.2%) reported functional decline at discharge and 317 (46.3%) at 1 month after discharge. Path analysis indicated that in-hospital mobility (standardized maximum likelihood estimate (SMLE) = -0.48, P < .001), continence care (SMLE = -0.12, P < .001), and length of stay (LOS) (SMLE = 0.06, P < .001) were directly related to functional decline at discharge and, together with personal risk factors, explained 64% of variance. In-hospital mobility, continence care, and LOS were indirectly related to functional decline at 1 month after discharge through functional decline at discharge (SMLE = 0.45, P < .001). Nutrition consumption (SMLE = -0.07, P < .001) was significantly related to functional decline at 1 month after discharge, explaining, together with other risk factors, 32% of variance.
  
  
  CONCLUSIONS
  In-hospital low mobility, suboptimal continence care, and poor nutrition account for immediate and 1-month posthospitalization functional decline. These are potentially modifiable hospitalization risk factors for which practice and policy should be targeted in efforts to curb the posthospitalization functional decline trajectory.
authors.affiliation: Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Israel.
authors.forename: Anna
authors.initials: A
authors.lastname: Zisberg
authors.forename: Efrat
authors.initials: E
authors.lastname: Shadmi
authors.forename: Nurit
authors.initials: N
authors.lastname: Gur-Yaish
authors.forename: Orly
authors.initials: O
authors.lastname: Tonkikh
authors.forename: Gary
authors.initials: G
authors.lastname: Sinoff
mesh_terms: D000203:Activities of Daily Living; D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006760:Hospitalization; D006801:Humans; D007557:Israel; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011446:Prospective Studies; D020127:Recovery of Function; D012307:Risk Factors
keywords: activities of daily living; functional decline; hospitalization; incontinence care; mobility