Hospitalized older adult: predictors of functional decline

Tavares, João Paulo de Almeida; Nunes, Lisa Alexandra Nogueira Veiga; Grácio, Joana Catarina Gonçalves

doi:10.1590/1518-8345.3612.3399

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Revista Latino-Americana de Enfermagem

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Original Article • Rev. Latino-Am. Enfermagem 29 • 2021 • https://doi.org/10.1590/1518-8345.3612.3399 copy

Hospitalized older adult: predictors of functional decline^* * Supported by Centro Hospitalar e Universitário de Coimbra, Portugal. This article was supported by National Funds through Fundação para a Ciência e a Tecnologia (FCT) within the CINTESIS R&D Unit (reference UIDB/4255/2020).

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

to identify the predictors of functional decline in hospitalized individuals aged 70 or over, between: baseline and discharge; discharge and follow-up, and baseline and three-month follow-up.

Method:

a prospective cohort study conducted in internal medicine services. A questionnaire was applied (clinical and demographic variables, and predictors of functional decline) at three moments. The predictors were determined using the binary logistic regression model.

Results:

the sample included 101 patients, 53.3% female, mean age of 82.47 ± 6.57 years old. The predictors that most contributed to decline in hospitalization were the following: previous hospitalization (OR=1.8), access to social support (OR=4.86), cognitive deficit (OR=6.35), mechanical restraint (OR=7.82), and not having a partner (OR=4.34). Age (OR=1.18) and medical diagnosis (OR=0.10) were the predictors between discharge and follow-up. Being older, delirium during hospitalization (OR=5.92), and presenting risk of functional decline (OR=5.53) were predictors of decline between the baseline and follow-up.

Conclusion:

the most relevant predictors were age, previous hospitalization, cognitive deficit, restraint, social support, not having a partner, and delirium. Carrying out interventions aimed at minimizing the impact of these predictors can be an important contribution in the prevention of functional decline.

Descriptors:
Aged; Health of the Elderly; Nursing; Hospitalization; Logistic Models; Functional Decline

Variable	Instrument	Collection moment
Age, gender, level of schooling, marital status, family nucleus	Sociodemographic questionnaire	Admission
Admission date, admission diagnosis(es), multimorbidity, number of previous hospitalizations, hospitalization period, number and type of medications, and therapeutical attitudes	Clinical questionnaire and Charlson Comorbidity Index	Admission
Cognitive decline	Cognitive Decrease Test (6CIT)⁽²³23 Apóstolo JLA, Paiva DDS, Silva RCG, Santos EJF, Schultz TJ. Adaptation and validation into Portuguese language of the six-item cognitive impairment test (6CIT). Aging Ment Health. [Internet]. 2018 Sep 2 [cited Mar 23, 2018];22(9):1190-5. Available from: https://www.tandfonline.com/doi/full/10.1080/13607863.2017. 1348473 https://www.tandfonline.com/doi/full/10.... ⁾	Admission
Senses (sight and hearing)	Question "can you see well?"; "can you hear well?"	Admission
Affective state	Single item of the Geriatric Depression Scale⁽²⁴24 Maboney J, Drinka TJK, Abler R, Gunter-Hunt G, Matthews C, Gravenstein S, et al. Screening for Depression: Single Question versus GDS. J Am Geriatr Soc. [Internet]. 1994 Sep [cited Mar 23, 2018];42(9):1006-8. Available from: http://doi.wiley.com/10.1111/j.1532-5415.1994.tb06597.x http://doi.wiley.com/10.1111/j.1532-5415... ⁾	During hospitalization (3 to 5 days after admission)
Fear of falling	Single item of fear of falling⁽²⁵25 Resnick B, Wells C, Galik E, Holtzman L, Zhu S, Gamertsfelder E, et al. Feasibility and Efficacy of Function-Focused Care for Orthopedic Trauma Patients. J Trauma Nurs. [Internet]. 2016 [cited Mar 23, 2018];23(3):144-55. Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00043860-201605000-00007 http://content.wkhealth.com/linkback/ope... ⁾	During hospitalization
Falls	Record of falls during hospitalization	Discharge
Pain	Numerical Scale or Qualitative Scale	During hospitalization
Delirium	Confusion Assessment Method⁽²⁶26 Sampaio F, Sequeira C. Tradução e validação do Confusion Assessment Method para a população portuguesa. Rev Enferm Ref. [Internet]. 2013 Mar 29 [Acesso 23 mar 2018];III Série(no 9):125-34. Disponível em: https://www.esenfc.pt/rr/index.php?module=rr⌖=publicationDetails&pesquisa=&id_artigo=2361&id_revista=9&id_edicao=51 https://www.esenfc.pt/rr/index.php?modul... ⁾	Admission and during hospitalization
Restraint	Observation grid of physical restriction⁽²⁷27 Faria H, Paiva A, Marques P. A restrição física da mobilidade - estudo sobre os aspetos ligados à sua utilização com fins terapêuticos. Rev Enferm Ref. [Internet]. 2012 Mar 31 [cited 23 mar 2018];III Série(no 6):7-16. Disponível em: http://www.esenfc.pt/rr/index.php?module=rr⌖=publicationDetails&pesquisa=&id_artigo=2274&id_revista=9&id_edicao=41 http://www.esenfc.pt/rr/index.php?module... ⁾	During hospitalization
Risk of functional decline	ISAR-HP - Portuguese version⁽²⁸28 Tavares J, Grácio J, Nunes L. Predictive validity of the Identification of Seniors at Risk - Hospitalized Patient tool for identifying functional decline. Rev Enferm Ref. [Internet]. 2017 Dec 18 [cited Aug 23, 2019];IV Série(No15):145-54. Available from: https://rr.esenfc.pt/rr/index.php?module=rr⌖=publicationDetails&pesquisa=&id_artigo=2751&id_revista=24&id_edicao=117 https://rr.esenfc.pt/rr/index.php?module... ⁾	Admission
Functional capacity of the OA	Katz Index⁽²⁹29 Simões AL, Ferreira PL, Dourado M. Medição da autonomia em atividades da vida diária. Port J Public Health. [Internet]. 2018 [Acesso 23 ago 2019];36(1):9-15. Disponível em: https://www.karger.com/DOI/10.1159/000492139 https://www.karger.com/DOI/10.1159/00049... ⁾	Admission, discharge and follow-up

Clinical characteristics	Patients without decline (n = 74)	Patients with decline (n = 27)	p/OR^* * OR = Odds Ratio;	Log^† † Log = Logistic; regression
Clinical characteristics	Patients without decline (n = 74)	Patients with decline (n = 27)	p/OR^* * OR = Odds Ratio;	p/OR
Age (M^‡ ‡ M = Mean; ±SD^§ § SD = Standard deviation; )	81.0 (6.08)	83.69 (6.77)	0.04^ Student's t test;	0.76/0.98
Male (%)	20 (42.6)	27 (57.4)	0.03^†† †† Chi-square test; /2.5	0.71/1.32
Without a partner (%)	37 (68.5)	17 (37)	0.01^†† †† Chi-square test; /3.7	0.02/4.34
With social support (t0) (%)	5 (12.5)	14 (31.8)	0.04^†† †† Chi-square test; /0.31	0.04/4.86
Hospitalizations in the last year (Median, 1^st and 3^rd)	0 (0 - 0)	0 (0 - 1)	<0.01^¤	0.03/1.80
Psychoactive drugs	20 (43.5)	34 (61.8)	0.07^†† †† Chi-square test;	0.13/2.77
Does not see well (%)	21 (45.7)	35 (63.6)	0.07^†† †† Chi-square test;	0.32/0.51
Does not hear well (%)	13 (28.3)	23 (41.8)	0.16^†† †† Chi-square test;	0.50/0.56
Fear of falling (%)	20 (47.6)	35 (67.3)	0.05^†† †† Chi-square test;	0.78/1.27
High risk of falls (%)	20 (44.4)	28 (50.9)	0.01^†† †† Chi-square test;	0.23/4.34
High risk of PI^\|\| \|\| PI = Pressure injur; (%)	8 (18.2)	24 (43.6)	<0.01^†† †† Chi-square test; /3.5	0.46/1.84
Cognitive decline (%)	12 (26.1)	30 (55.6)	<0.01^†† †† Chi-square test; /3.5	<0.01/6.35
Depression	25 (55.6)	43 (78.6)	0.02^†† †† Chi-square test;	0.97/0.96
Delirium at admission (%)	-	9 (16.4)	<0.01^†† †† Chi-square test; /2	-
Delirium during hospitalization (%)	2 (4.8)	8 (15.1)	0.18^†† †† Chi-square test;	0.46/2.84
Restraint (%)	6 (14.3)	27 (51.9)	<0.01^†† †† Chi-square test; /6.5	<0.01/7.82
CCF^¶ ¶ CCF = Care Centered on Functionality; (Me, 1^st and 3^rd Q)	0.5 (0.22 - 0.56)	0.47 (0.36 - 0.63)	0.30^‡‡ ‡‡ Mann-Whitney's U test	0.69/1.91
Risk of functional decline (%)	30 (65.2)	47 (85.5)	0.02^†† †† Chi-square test; /3.1	0.84/1.22

Clinical characteristics	Patients without decline (n = 74)	Patients with decline (n = 27)	p/OR^* * OR = Odds Ratio;	Log^† † Log = Logistic; regression
Clinical characteristics	Patients without decline (n = 74)	Patients with decline (n = 27)	p/OR^* * OR = Odds Ratio;	p/OR
Age (Median, 1^st and 3^rd Q)	81 (76 - 87)	86 (83 - 89)	<0.01^§ § Mann-Whitney's U test;	<0.01/1.18
Admission diagnosis (%) Infectious disease	39 (38.6)	4 (4)	<0.01^\|\| \|\| Fisher's test;	<0.01/0.10
Number of medications (Median, 1^st and 3^rd Q)	6.5 (3.75 - 10)	8 (6 - 11)	0.11^§ § Mann-Whitney's U test;	0.48/1.05
Hospitalizations in the last year (Median, 1^st and 3^rd Q)	0 (0 - 1)	1 (0 - 1)	0.03^§ § Mann-Whitney's U test;	0.077/0.92
CCI^‡ ‡ CCI = Charlson Comorbidity Index; (Median, 1^st and 3^rd Q)	4 (4 - 7)	6 (5 - 8)	0.01^§ § Mann-Whitney's U test;	0.21/1.2
Does not hear well (%)	23 (31.1)	13 (48.1)	0.11^¶ ¶ Chi-square test	0.92/1.08
Weight loss (%)	49 (66.2)	23 (85.2)	0.06^¶ ¶ Chi-square test	0.39/1.84
Delirium during hospitalization (%)	5 (7.2)	5 (19.2)	0.13^\|\| \|\| Fisher's test;	0.16/3.62
Cognitive decline (%)	28 (37.8)	14 (53.8)	0.15^¶ ¶ Chi-square test	0.44/1.593
Risk of functional decline (%)	51 (68.9)	26 (96.3)	<0.01^¶ ¶ Chi-square test /11.7	0.14/5.29

Clinical characteristics	Patients without decline (n = 74)	Patients with decline (n = 27)	p/OR^* * OR = Odds Ratio;	Log^† † Log = Logistic; regression
Clinical characteristics	Patients without decline (n = 74)	Patients with decline (n = 27)	p/OR^* * OR = Odds Ratio;	p/OR
Age (M^‡ ‡ M = Median; ±SD^§ ‡‡ Mann-Whitney's U test )	80.34 (6.22)	85.77 (5.77)	0.00^ Student's t test;	0.04/1.10
With social support (t0) (%)	9 (17.3)	10 (31.3)	0.14^†† †† Chi-square test;	0.43/1.65
Hospitalizations in the last year (%)	0 (0 - 1)	0 (0 - 1)	0.09^‡‡ ‡‡ Mann-Whitney's U test;	0.99/0.99
CCI^\|\| \|\| CCI = Charlson Comorbidity Index; (Me, 1^st and 3^rd Q)	5 (4 - 7)	6 (4 - 7)	0.04^‡‡ ‡‡ Mann-Whitney's U test;	0.29/1.14
ERRD^¶ ¶ ERRD = Estimated Relative Risk of Death; (Me, 1^st and 3^rd Q)	6.38 (4.4 - 13.37)	9.23 (6.38 - 13.37)	0.05^‡‡ ‡‡ Mann-Whitney's U test;	0.87/1.02
Does not hear well (%)	18 (29.5)	18 (45.0)	0.11^†† †† Chi-square test;	0.74/0.83
Cognitive decline (%)	21(34.5)	21 (53.8)	0.06^†† †† Chi-square test;	0.62/1.35
Depression	35 (58)	33 (82.5)	0.02^†† †† Chi-square test; /0.3	0.14/2.35
Delirium during hospitalization (%)	2 (3.6)	8 (20.5)	0.01^§§ §§ Fisher's test	0.06/5.9
Restraint (%)	15 (26.8)	18 (47.4)	0.13^†† †† Chi-square test;	0.88/1.02
Length of hospitalization (Median, 1^st and 3^rd Q)	7 (5 - 10)	9 (6 - 17.5)	0.05^‡‡ ‡‡ Mann-Whitney's U test;	0.97/0.99
Risk of functional decline (%)	39 (63.9)	38 (95.0)	<0.01^†† †† Chi-square test; /10.72	0.04/5.53

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[1] Corresponding author: João Paulo de Almeida Tavares E-mail: joaoptavares@ua.pt

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Hospitalized older adult: predictors of functional decline* * Supported by Centro Hospitalar e Universitário de Coimbra, Portugal. This article was supported by National Funds through Fundação para a Ciência e a Tecnologia (FCT) within the CINTESIS R&D Unit (reference UIDB/4255/2020).

Objective:

Method:

Results:

Conclusion:

Hospitalized older adult: predictors of functional decline^* * Supported by Centro Hospitalar e Universitário de Coimbra, Portugal. This article was supported by National Funds through Fundação para a Ciência e a Tecnologia (FCT) within the CINTESIS R&D Unit (reference UIDB/4255/2020).