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functional status in hospitalized elderly

Complications: - loss of ability to perform basic activities of daily living (bADLs) during hospitalization portends substantial 1-year morbidity & mortality in older patients [1] - elderly with loss of bADLs during hospitalization - 30% will regain baseline functional status at 1 year - 41% will die - in contrast, elderly who maintain bADLs during hospitalization - 67% still maintained baseline status at 1 year - 18% will die Management: - admission to acute geriatric unit associated with lower risk of functional decline & greater chance of discharge to home from the hospital (GRS9) [3] - comprehensive geriatric assessment after emergency hospitalization improves likelihood that older patients will remain alive & living at home [2] - walk 2-3 times/day to prevent functional decline [3,4] - interventions that rely on exercise alone are not effective in improving functional status (GRS9) [3] - no evidence of improvement in functional benefit or reduction in length of hospital stay with supplements of protein or energy [7]

Related

hospitalization

General

functional status; performance status

References

  1. Boyd CM et al. Recovery of activities of daily living in older adults after hospitalization for acute medical illness. J Am Geriatr Soc 2008 Dec; 56:2171. PMID: 19093915
  2. Ellis G et al. Comprehensive geriatric assessment for older adults admitted to hospital: Meta-analysis of randomised controlled trials. BMJ 2011 Oct 27; 343:d6553 PMID: 22034146 - Stuck AE and Iliffe S. Comprehensive geriatric assessment for older adults. BMJ 2011 Oct 27; 343:d6799. PMID: 22034147 - Ellis G, Whitehead MA, O'Neill D, Langhorne P, Robinson D. Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database Syst Rev. 2011 Jul 6;(7):CD006211 PMID: 21735403
  3. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013 - Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
  4. Zisberg A, Shadmi E, Sinoff G et al Low mobility during hospitalization and functional decline in older adults. J Am Geriatr Soc. 2011 Feb;59(2):266-73. PMID: 21314647
  5. Baztan JJ, Caceres LA, Llanque JL, Gavidia JJ, Ruiperez I. Predictors of functional recovery in older hospitalized adults. J Am Geriatr Soc. 2012 Jan;60(1):187-9. PMID: 22239317
  6. Kosse NM, Dutmer AL, Dasenbrock L, Bauer JM, Lamoth CJ. Effectiveness and feasibility of early physical rehabilitation programs for geriatric hospitalized patients: a systematic review. BMC Geriatr. 2013 Oct 10;13:107. Review. PMID: 24112948 Free PMC Article
  7. Milne AC, Potter J, Vivanti A, Avenell A. Protein and energy supplementation in elderly people at risk from malnutrition. Cochrane Database Syst Rev. 2009 Apr 15;(2):CD003288. Review. PMID: 19370584