title: Even a small change can make a big difference: the case of in-hospital cognitive decline and new IADL dependency.
abstract: post-hospitalisation functional decline is a widely described phenomenon, yet factors related to new disability in instrumental activities of daily living (IADL) in previously independently functioning older adults are rarely studied.
  
  
  
  to test whether change in cognitive status from admission to discharge during short-term acute-care hospitalisation is associated with the incidence of medium-term post-hospitalisation IADL dependency.
  
  
  
  prospective cohort study.
  
  
  
  internal medicine wards in two Israeli medical centres.
  
  
  
  two hundred and seventy-two hospitalised older adults (≥70) who were independent in self-care and mobility activities at admission, at discharge and 1 month after discharge, and who were independent in IADL pre-admission.
  
  
  
  cognitive status was evaluated at admission and at discharge using Pfeiffer's Short Portable Mental Status Questionnaire (SPMSQ). One-month post-discharge, IADL was assessed using Lawton and Brody's scale by telephone.
  
  
  
  incidence of IADL dependency was 74/272 (27.2%). Controlling for length of stay, co-morbidities, re-hospitalisation and age, a one-unit decrease in SPMSQ score during hospital stay was associated with 1.57 higher odds (95% CI, 1.14-2.15) of post-hospitalisation new IADL dependency. The odds of new IADL dependency were also significantly higher in participants who were rehospitalised within the previous month (odds ratio = 2.65; 95% CI, 1.25-5.62).
  
  
  
  decline in SPMSQ score during acute hospitalisation has a detrimental effect on functional decline after acute hospitalisation, defined by incidence IADL dependency. This finding emphasises the need to identify cognitive decline during hospitalisation to allow timely intervention to prevent post-discharge functional decline in this population.
authors.affiliation: The Cheryl Spencer Department of Nursing, University of Haifa, Haifa 3498838, Israel.
authors.forename: Anna
authors.initials: A
authors.lastname: Zisberg
authors.affiliation: Department of Gerontology, University of Haifa, Haifa, Israel.
authors.forename: Gary
authors.initials: G
authors.lastname: Sinoff
authors.affiliation: The Cheryl Spencer Department of Nursing, University of Haifa, Haifa 3498838, Israel.
authors.forename: Maayan
authors.initials: M
authors.lastname: Agmon
authors.affiliation: The Cheryl Spencer Department of Nursing, University of Haifa, Haifa 3498838, Israel.
authors.forename: Orly
authors.initials: O
authors.lastname: Tonkikh
authors.affiliation: Department of Gerontology, University of Haifa, Haifa, Israel.
authors.forename: Nurit
authors.initials: N
authors.lastname: Gur-Yaish
authors.affiliation: The Cheryl Spencer Department of Nursing, University of Haifa, Haifa 3498838, Israel.
authors.forename: Efrat
authors.initials: E
authors.lastname: Shadmi
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003072:Cognition Disorders / Q000175:diagnosis* / Q000523:psychology; D000066492:Cognitive Aging / Q000523:psychology*; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D007557:Israel; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D000073216:Mental Status and Dementia Tests; D015999:Multivariate Analysis; D016017:Odds Ratio; D010351:Patient Discharge; D010359:Patient Readmission; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: cognition; function; hospitalisation; older people