Abstract
Pathophysiological changes after acute hospitalizations may influence physical functioning in older adults, which can lead to disability and loss of independence. This study evaluated the association between pneumonia, fracture, heart attack, stroke, and other hospitalizations with major mobility disability (MMD) and gait speed. This was a secondary analysis of the Lifestyle Interventions and Independence for Elders (LIFE) Study, which was conducted across eight sites during 2010–2013 with longitudinal follow-up for 1635 individuals over an average of 2.6 years. Participants included adults ≥70 years old with pre-existing mobility limitations randomized to a physical activity intervention or a health education control arm. Hospitalizations were recorded via self-report and adjudicated by medical reviewers. MMD was measured by the inability to complete a 400 m walk test, or other proxies, as a binary outcome. Gait speed was recorded during the walk test in meters per second (m/s) and measured on a linear scale. Mixed-effects repeated measures regression adjusted for baseline demographics, comorbid conditions, and frailty. Among the 1635 participants, there were 1458 hospitalizations, which included 80 (5.5% of all hospitalizations) cases of pneumonia, 92 (6.3%) hospitalized fractures, 87 (6.0%) heart attacks, and 61 (4.2%) strokes. In the short-term measurement period immediately following hospitalization (1 day to 6 months), stroke (OR = 3.98 (3.41–4.54)) had the strongest association with MMD followed by fracture (OR = 3.03 (2.54–3.52)), pneumonia (OR = 2.76 (2.23–3.30)), and heart attack (OR = 2.03 (1.52–2.53)). Associations with long-term (6–12 months after) MMD were decreased or not significant for all causes. Pneumonia, fracture, stroke, and other hospitalizations were associated with short-term relative gait speed changes between −4.8% up to −19.5%, and only fracture was associated with long-term changes. Hospitalizations for pneumonia, heart attack, stroke, and fractures were associated with short-term decreases in mobility in older adults. Older adults may be at risk for decreased mobility and disability following acute hospitalizations, with the magnitude determined by the cause of the precipitating event.
Highlights
This study evaluated the associations between hospitalizations and major mobility disability (MMD) and gait speed as measures of physical functioning
The analyses separately focused on two exposure–outcome relationships: (1) the “short-term” effects represented by the assessment period immediately following the hospitalization; and (2) the “long-term” effects represented by the subsequent assessment period after hospitalization
There was a total of 1458 hospitalizations, which included 80 (5.5% of all hospitalizations) cases of pneumonia, 92 (6.3%) hospitalized fractures, 87 (6.0%) heart attacks, and 61 (4.2%) strokes
Summary
Using robust and objectively measured outcomes from the Lifestyle Interventions and Independence for Elders (LIFE) Study [16,17], the immediate and long-term associations of pneumonia, fracture, heart attack, stroke, and other hospitalizations on MMD and gait speed were assessed These hospitalization subtypes (pneumonia, fracture, heart attack, and stroke) were analyzed as they are acute onset events (compared to pre-existing conditions) that often lead to pathophysiological changes that may impact physical functioning [18,19,20,21,22]. These conditions are associated with high readmission rates and healthcare costs with significant morbidity and mortality risk in older adults [23]. The study hypothesis was that these hospitalization subtypes would be associated with significant decrements in physical functioning in both the short-term and long-term measurement periods, compared to other hospitalizations
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