Over 30 % of older patients experience hospitalization-associated disability (HAD) (i.e., loss of independence in Activities of Daily Living (ADLs)) after an acute hospitalization. Despite its high ...prevalence, the mechanisms that underlie HAD remain elusive. This paper describes the protocol for the Hospital-Associated Disability and impact on daily Life (Hospital-ADL) study, which aims to unravel the potential mechanisms behind HAD from admission to three months post-discharge.
The Hospital-ADL study is a multicenter, observational, prospective cohort study aiming to recruit 400 patients aged ≥70 years that are acutely hospitalized at departments of Internal Medicine, Cardiology or Geriatrics, involving six hospitals in the Netherlands. Eligible are patients hospitalized for at least 48 h, without major cognitive impairment (Mini Mental State Examination score ≥15), who have a life expectancy of more than three months, and without disablement in all six ADLs. The study will assess possible cognitive, behavioral, psychosocial, physical, and biological factors of HAD. Data will be collected through: 1 medical and demographical data; 2 personal interviews, which includes assessment of cognitive impairment, behavioral and psychosocial functioning, physical functioning, and health care utilization; 3 physical performance tests, which includes gait speed, hand grip strength, balance, bioelectrical impedance analysis (BIA), and an activity tracker (Fitbit Flex), and; 4 analyses of blood samples to assess inflammatory and metabolic markers. The primary endpoint is additional disabilities in ADLs three months post-hospital discharge compared to ADL function two weeks prior to hospital admission. Secondary outcomes are health care utilization, health-related quality of life (HRQoL), physical performance tests, and mortality. There will be at least five data collection points; within 48 h after admission (H1), at discharge (H3), and at one (P1; home visit), two (P2; by telephone) and three months (P3; home visit) post-discharge. If the patient is admitted for more than five days, additional measurements will be planned during hospitalization on Monday, Wednesday, and Friday (H2).
The Hospital-ADL study will provide information on cognitive, behavioral, psychosocial, physical, and biological factors associated with HAD and will be collected during and following hospitalization. These data may inform new interventions to prevent or restore hospitalization-associated disability.
Hospitalization-associated disability affects up to 60% of older adults; however, standardized measures of function are not routinely used and documented. We sought to determine whether nursing ...documentation in electronic medical records can be used to determine mobility status and associated clinical outcomes.
A retrospective study of 2383 medical patients aged 75 years and older was conducted at a large academic tertiary hospital in New York. Mobility (low, intermediate, and high) was the primary variable of interest. Short-term clinical outcomes, including length of stay (LOS), discharge disposition, and readmissions, were the primary outcome variables.
Average age and Charlson Comorbidity Index were 84.7 (range 74-107) and 6.46, respectively; 84.5% of patients were documented to have been ambulatory before admission. More than half (52.8%) of the subjects with in-hospital mortality were in the low mobility group (27.2 vs 0.27 vs 0,
< 0.0001). Low mobility was associated with increased LOS (7.42 vs 5.69 vs 4.14,
< 0.0001), discharge to a skilled nursing facility (39.36 vs 14.67 vs 1.91,
< 0.0001), and 30-day readmission (24.40 vs 16.67 vs 10.93,
< 0.0001). After controlling for demographics, ambulatory status before admission, and Charlson Comorbidity Index, low mobility was statistically significantly associated with increased LOS, discharge to a skilled nursing facility, and 30-day readmissions.
The use of documented nursing observation may provide a practical way to systematically identify patients at risk for poor outcomes associated with low mobility to ultimately improve outcomes of hospitalized older adults.
Objective: The aim of this study was to examine the relationship between the frequency and duration of physical therapy (PT) and the development of hospitalization-associated disability (HAD) in ...hospitalized geriatric patients with heart failure (HF). Methods: This single-center, retrospective, observational study included hospitalized patients with HF aged 65 years or older who had received PT. Data regarding demographics, comorbidities, laboratory findings, medications, rehabilitation, and activities of daily living (ADLs) status were collected from electronic medical records. Based on the average frequency and duration of PT, patients were divided into three groups: Group 1, ≥3 days/week and ≥120 minutes/week; Group 2, ≥3 days/week and <120 minutes/week; and Group 3, <3 days/week and <120 minutes/week. Logistic regression analysis was performed to identify the association between the average frequency and duration of weekly PT and the incidence of HAD. Results: In all, 105 patients (mean age, 84.8 years; proportion of women, 59%) were enrolled in the study, and 43 (41.0%) patients exhibited HAD at discharge. In the multivariate logistic regression analysis, Group 2 (odds ratio OR, 3.66) and Group 3 (OR, 6.71) had a significantly elevated risk of developing HAD using Group 1 as the reference, even after adjusting for age, ADLs before admission, cognitive function, and severity of HF. Conclusion: This study showed that a lower frequency and shorter duration of PT are associated with developing HAD in hospitalized geriatric patients with HF. However, further prospective studies are required to confirm these findings.
Objectives: The prevalence of peripheral arterial disease (PAD) is on the rise, with endovascular treatment being a widely accepted surgical intervention. Patients with PAD often experience reduced ...activities of daily living (ADL). Therefore, we conducted a retrospective cohort study to investigate the impact of early rehabilitation after endovascular treatment in patients with PAD.Methods: Using data from the JMDC hospital database, the study included 529 patients who were hospitalized for PAD and underwent endovascular treatment. Patients were classified into two independent variables: early rehabilitation group (rehabilitation started within 2 days postoperatively) and control group (rehabilitation started within 3–7 days postoperatively). The outcome measures were the occurrence of hospital-associated disability (HAD) and duration of hospitalization.Results: Unadjusted data showed that the early rehabilitation group (n=469) had fewer HAD events (8.5% vs. 23.3%, P <0.001) and a shorter mean hospitalization duration (4.4 vs. 18.9 days, P <0.001) than the control group (n=60). The difference remained significant after adjustment by propensity score analysis.Conclusions: In patients with PAD, early rehabilitation after endovascular treatment may be beneficial in preventing the development of HAD and reducing the duration of hospitalization.
Children and adolescents who present with various chronic pain experiences and associated functional disability often share common behavioral and clinical features. Caring for these patients is ...challenging to health care providers and expensive for the medical community. Given the complexity of interrelated medical, psychological, and environmental variables potentially involved, a biopsychosocial conceptualization of assessment and treatment is helpful. Recent research has been able to demonstrate the effectiveness of treating children and adolescents suffering from chronic pain within an interdisciplinary rehabilitation environment. An interdisciplinary inpatient behavioral rehabilitation approach is described in detail along with how it compares to related day-hospital pain programs and outpatient services.
Background:Hospitalization-associated disability (HAD) is associated with prolonged functional decline and increased mortality after discharge. Therefore, we examined the incidence and risk factors ...associated with HAD in elderly patients undergoing cardiac surgery in Japan.Methods and Results:We retrospectively examined 2,262 elderly patients who underwent elective cardiac surgery at Sakakibara Heart Institute. HAD was defined as a functional decline between time of admission and discharge measured by the Barthel Index. We analyzed clinical characteristics using machine learning algorithms to identify the risk factors associated with HAD. After excluding 203 patients, 2,059 patients remained, of whom 108 (5.2%) developed HAD after cardiac surgery. The risk factors identified were age, serum albumin concentration, estimated glomerular filtration rate, Revised Hasegawa’s Dementia Scale, N-terminal pro B-type natriuretic peptide, vital capacity, preoperative Short Physical Performance Battery (SPPB) score, operation times, cardiopulmonary bypass times, ventilator times, length of postoperative intensive care unit stay, and postoperative ambulation start day. The highest incidence of HAD was found in patients with an SPPB score ≤9 and in those who started ambulation >6 days after surgery (76.9%).Conclusions:Several risk factors for HAD are components of frailty, suggesting that preoperative rehabilitation to reduce the risk of HAD is feasible. Furthermore, the association between HAD and a delayed start of ambulation reaffirms the importance of early mobilization and rehabilitation.
Background:Hospitalization-associated disability (HAD) is associated with prolonged functional decline and increased mortality after discharge. Therefore, we examined the incidence and risk factors ...associated with HAD in elderly patients undergoing cardiac surgery in Japan.Methods and Results:We retrospectively examined 2,262 elderly patients who underwent elective cardiac surgery at Sakakibara Heart Institute. HAD was defined as a functional decline between time of admission and discharge measured by the Barthel Index. We analyzed clinical characteristics using machine learning algorithms to identify the risk factors associated with HAD. After excluding 203 patients, 2,059 patients remained, of whom 108 (5.2%) developed HAD after cardiac surgery. The risk factors identified were age, serum albumin concentration, estimated glomerular filtration rate, Revised Hasegawa’s Dementia Scale, N-terminal pro B-type natriuretic peptide, vital capacity, preoperative Short Physical Performance Battery (SPPB) score, operation times, cardiopulmonary bypass times, ventilator times, length of postoperative intensive care unit stay, and postoperative ambulation start day. The highest incidence of HAD was found in patients with an SPPB score ≤9 and in those who started ambulation >6 days after surgery (76.9%).Conclusions:Several risk factors for HAD are components of frailty, suggesting that preoperative rehabilitation to reduce the risk of HAD is feasible. Furthermore, the association between HAD and a delayed start of ambulation reaffirms the importance of early mobilization and rehabilitation.
The purpose of this study was to investigate the prevalence of pain symptoms causing disabilities in every-day activities and their possible connection to depressive symptomatology. A representative ...sample of 12640 adults from the Hungarian population participated in a door-to-door survey about demographic variables, pain-associated disability, and depressive symptomatology. The overall prevalence of pain-associated disability was 32.7%, significantly lower in men, showing a significant increasing trend with age. A decreasing tendency in prevalence rates was observed in connection with higher educational and occupational status. Results revealed a 30.2% prevalence of depressive symptomatology among interviewees reporting pain-associated disabilities. The co-prevalence of depressive symptoms revealed a significant increasing trend with age and lower educational level. No significant gender difference was found in the co-occurrence of depressive symptoms. This survey concludes that pain symptoms constitute a substantial public health problem in the Hungarian population in forms of emerging disabilities and depression. Epidemiological studies offer a better understanding of sociodemographic differences in health status, and serve the better allocation of professional and economic resources.
We report on the systematic trial for the HAD development prevention that start before the hospitalization. In aging society, prevention of the hospitalization-associated disability (HAD) is an ...important element of caregiving as it makes bed rest by hospitalization, and would contribute to maintain or raise the quality of life of elderly patient. About 20-40% of the elderly patients hospitalized for acute medical illness develop HAD. Once developed, HAD is difficult to improve and prevention of HAD is an urgent issue to discuss. We have developed a screening sheet for identifying at-risk patients of HAD. This sheet consists of three elements；exclusion criteria, a criterion of judgement, and an intervention plan. The flow chart was developed based on the screening sheet so that patients could be divided into three groups：1) no intervention group, 2) self-rehabilitation group, and 3) physiotherapist intervention group. The self-rehabilitation group used exercise program that nurses collaborated to construct with the orthopedist, dementia specialist, and the physiotherapist.
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