title: Physical Function and Disability After Acute Care and Critical Illness Hospitalizations in a Prospective Cohort of Older Adults.
abstract: OBJECTIVE
  To investigate associations between acute care and critical illness hospitalizations and performance on physical functional measures and activities of daily living (ADLs).
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Large health maintenance organization.
  
  
  METHODS
  Two thousand nine hundred twenty-six participants in Adult Changes in Thought, a study of aging enrolling dementia-free individuals aged 65 and older not living in a nursing home from 1994 to September 30, 2008 (N = 2,926).
  
  
  METHODS
  The exposure of interest was hospitalization during study participation, subdivided by presence of critical illness. Outcomes included gait speed, grip strength, chair stand speed, and difficulty and dependence in performing ADLs measured at biennial visits.
  
  
  RESULTS
  Median time between hospital discharge and the next study visit was 311 days (interquartile range (IQR) 151-501 days) after acute care hospitalization and 359 days (IQR 181-420 days) after critical illness hospitalization. Gait speed was slower after acute care (-0.05 m/s, 95% confidence interval (CI) = 0.01-0.04 m/s slower, P < .001) and critical illness (-0.16 m/s, 95% CI = -0.22 to -0.10, P < .001). Grip was weaker after acute care hospitalization (-0.8 kg, 95% CI = -1.0 to -0.6, P < .001) but not significantly different after critical illness hospitalization. Chair-stand speed was slower after acute care hospitalization (-0.04 stands/s, 95% CVI = -0.05 to -0.04, P < .001) and critical illness hospitalization (-0.09, 95% CI = -0.15 to -0.03, P = .003). The odds of difficulty with (odds ratio (OR) = 1.4, 95% CI = 1.2-1.6, P < .001) or dependence in (OR = 2.0, 95% CI = 1.2-3.2, P = .006) one or more ADLs was higher after acute care hospitalization, as were the odds of difficulty with (OR = 1.9, 95% CI = 1.1-3.6, P = .03) or dependence in (OR = 7.9, 95% CI = 2.5-25.7, P = .001) one or more ADLs after critical illness.
  
  
  CONCLUSIONS
  In older adults, hospitalization, especially for critical illness, was associated with clinically relevant decline in gait and chair stand speed and strongly associated with difficulty with and dependence in ADLs.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin.
authors.forename: William J
authors.initials: WJ
authors.lastname: Ehlenbach
authors.affiliation: Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin.|Group Health Research Institute, Seattle, Washington.|Department of Medicine, Harborview Medical Center, University of Washington, Seattle, Washington.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Larson
authors.affiliation: Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, Washington.
authors.forename: J Randall
authors.initials: JR
authors.lastname: Curtis
authors.affiliation: Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, Washington.
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Hough
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D016638:Critical Illness / Q000453:epidemiology*; D004185:Disability Evaluation; D006233:Persons with Disabilities; D005260:Female; D005684:Gait; D018737:Hand Strength; D006760:Hospitalization; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies; D014861:Washington / Q000453:epidemiology
keywords: activities of daily living; critical illness; disability; gait speed; long-term outcomes