title: Hospital-acquired functional decline in older patients cared for in acute medical wards and predictors: Findings from a multicentre longitudinal study.
abstract: Describing the trajectories of hospital-associated functional decline in older patients admitted to acute medical units and identifying predictors at the individual, nursing, and hospital levels, were the aims of the study. A longitudinal survey among 12 acute medical units in which 1464 patients were consecutively enrolled and evaluated using the Barthel Index (BI), was performed. Functional decline was defined as a decrease in the BI of at least 5 points from admission to discharge. In all, 17.1% participants (n = 251) demonstrated functional decline. In accordance with multiple logistic regression analysis, 28.8% (R(2)) of the variance in the functional decline was explained by: confusion/disorientation (RR = 4.684; 95% CI = 3.144-6.978), admission from nursing homes (RR = 2.464; 95% CI = 1.642-3.697), daily care expressed in minutes offered by nursing aides (RR = 1.535; 95% CI = 1.275-1.849), higher workforce skill-mix (RR = 2.221; 95% CI = 1.763-2.797), bladder catheter insertion (RR = 1.599; 95% CI = 1.128-2.268), and higher BI score at admission (RR = 1.019; 95% CI = 1.014-1.024). Increasing the amount of care delivered by competent nurses-having a bachelors degree-providing and supervising direct-care activities, may reduce the occurrence of functional decline in older patients admitted to medical units.
authors.affiliation: Udine University, Viale Ungheria 20, 33100, Italy. Electronic address: alvisa.palese@uniud.it.
authors.forename: Alvisa
authors.initials: A
authors.lastname: Palese
authors.affiliation: Verona University, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Gonella
authors.affiliation: Udine University, Viale Ungheria 20, 33100, Italy.
authors.forename: Renzo
authors.initials: R
authors.lastname: Moreale
authors.affiliation: Azienda per i Servizi Sanitari Provincia Trento, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Guarnier
authors.affiliation: Azienda per i Servizi Sanitari Provincia Trento, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Barelli
authors.affiliation: Azienda per i Servizi Sanitari Provincia Trento, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Zambiasi
authors.affiliation: Azienda Ospedaliera Verona, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Allegrini
authors.affiliation: Fondazione Poliambulanza Brescia, Italy.
authors.forename: Letizia
authors.initials: L
authors.lastname: Bazoli
authors.affiliation: Azienda Unità Sanitaria Locale n. 9 Treviso, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Casson
authors.affiliation: Azienda per i Servizi Sanitari n. 2 "Isontina", Gorizia, Italy.
authors.forename: Meri
authors.initials: M
authors.lastname: Marin
authors.affiliation: Azienda Unità Sanitaria Locale n. 6 Vicenza, Italy.
authors.forename: Marisa
authors.initials: M
authors.lastname: Padovan
authors.affiliation: Azienda per i Servizi Sanitari n.4 "Medio Friuli", Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Picogna
authors.affiliation: Azienda Ospedaliera. S.Orsola - Malpighi, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Taddia
authors.affiliation: Fondazione Zancan, Padova, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Salmaso
authors.affiliation: Bologna University, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Chiari
authors.affiliation: Azienda Ospedaliero-Universitaria, Padua, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Frison
authors.affiliation: Verona University, Italy.
authors.forename: Oliva
authors.initials: O
authors.lastname: Marognolli
authors.affiliation: Verona University, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Benaglio
authors.affiliation: Verona University, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Canzan
authors.affiliation: Verona University, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Ambrosi
authors.affiliation: Verona University, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Saiani
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D003221:Confusion; D015577:Geriatric Assessment; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D008137:Longitudinal Studies; D012307:Risk Factors; D014546:Urinary Catheterization
keywords: Functional dependence; Functional recovery; Functional stability; Hospital; Longitudinal study; Medical units; Nursing care; Predictors