title: Hospitalization-Associated Disability in Adults Admitted to a Safety-Net Hospital.
abstract: BACKGROUND
  Little is known about hospitalization-associated disability (HAD) in older adults who receive care in safety-net hospitals.
  
  
  OBJECTIVE
  To describe HAD and to examine its association with age in adults aged 55 and older hospitalized in a safety-net hospital.
  
  
  METHODS
  Secondary post hoc analysis of a prospective cohort from a discharge intervention trial, the Support from Hospital to Home for Elders.
  
  
  METHODS
  Medicine, cardiology, and neurology inpatient services of San Francisco General Hospital, a safety-net hospital.
  
  
  METHODS
  A total of 583 participants 55 and older who spoke English, Spanish, or Chinese. We determined the incidence of HAD 30 days post-hospitalization and ORs for HAD by age group.
  
  
  METHODS
  The outcome measure was death or HAD at 30 days after hospital discharge. HAD is defined as a new or additional disability in one or more activities of daily living (ADL) that is present at hospital discharge compared to baseline. Participants' functional status at baseline (2 weeks prior to admission) and 30 days post-discharge was ascertained by self-report of ADL function.
  
  
  RESULTS
  Many participants (75.3 %) were functionally independent at baseline. By age group, HAD occurred as follows: 27.4 % in ages 55-59, 22.2 % in ages 60-64, 17.4 % in ages 65-69, 30.3 % in ages 70-79, and 61.7 % in ages 80 or older. Compared to the youngest group, only the adjusted OR for HAD in adults over 80 was significant, at 2.45 (95 % CI 1.17, 5.15).
  
  
  CONCLUSIONS
  In adults at a safety-net hospital, HAD occurred in similar proportions among adults aged 55-59 and those aged 70-79, and was highest in the oldest adults, aged ≥ 80. In safety-net hospitals, interventions to reduce HAD among patients 70 years and older should consider expanding age criteria to adults as young as 55.
authors.affiliation: Division of General Internal Medicine, University of California, San Francisco/San Francisco General Hospital and Trauma Center, 1001 Potrero Avenue, Box 1364, San Francisco, 94143, CA, USA. anna.chodos@ucsf.edu.|Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA. anna.chodos@ucsf.edu.
authors.forename: Anna H
authors.initials: AH
authors.lastname: Chodos
authors.affiliation: Division of General Internal Medicine, University of California, San Francisco/San Francisco General Hospital and Trauma Center, 1001 Potrero Avenue, Box 1364, San Francisco, 94143, CA, USA.
authors.forename: Margot B
authors.initials: MB
authors.lastname: Kushel
authors.affiliation: Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: S Ryan
authors.initials: SR
authors.lastname: Greysen
authors.affiliation: Division of General Internal Medicine, University of California, San Francisco/San Francisco General Hospital and Trauma Center, 1001 Potrero Avenue, Box 1364, San Francisco, 94143, CA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Guzman
authors.affiliation: Division of Hospital Medicine, University of California, San Francisco/San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.
authors.forename: Eric R
authors.initials: ER
authors.lastname: Kessell
authors.affiliation: Division of General Internal Medicine, University of California, San Francisco/San Francisco General Hospital and Trauma Center, 1001 Potrero Avenue, Box 1364, San Francisco, 94143, CA, USA.
authors.forename: Urmimala
authors.initials: U
authors.lastname: Sarkar
authors.affiliation: Division of General Internal Medicine, University of California, San Francisco/San Francisco General Hospital and Trauma Center, 1001 Potrero Avenue, Box 1364, San Francisco, 94143, CA, USA.
authors.forename: L Elizabeth
authors.initials: LE
authors.lastname: Goldman
authors.affiliation: Division of Hospital Medicine, University of California, San Francisco/San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Critchfield
authors.affiliation: Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA.|Division of Hospital Medicine, University of California, San Francisco/San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.
authors.forename: Edgar
authors.initials: E
authors.lastname: Pierluissi
mesh_terms: D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D015577:Geriatric Assessment; D015438:Health Behavior; D006305:Health Status Indicators; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D012307:Risk Factors; D064876:Safety-net Providers; D012959:Socioeconomic Factors
keywords: Activities of daily living; Frail elderly; Hospitalization; Hospitalization-associated disability; Vulnerable populations