Abstract
BackgroundFatigability is an important marker of functional decline in community dwelling older people, yet its relationship with functional decline after hospitalization is unclear. The objectives of this study were to identify trajectories of fatigability and mobility over time and to examine the association between demographic and clinical characteristics and these trajectories in medical patients aged 70 years and older admitted to a Dutch tertiary care teaching hospital.MethodsIn this prospective cohort study with baseline (in-hospital), discharge, three-, and six-months post discharge follow-up measurements, fatigability was assessed by the physical subscale of the Pittsburgh Fatigability Scale (PFS). Mobility was assessed by the De Morton Mobility Index (DEMMI). Group-based trajectory modeling was used to identify joint trajectories of fatigability and mobility. Covariates included demographic (age, sex, living situation, education) and clinical characteristics (functional status, frailty status, depression, comorbidity, length of hospital stay).ResultsAmong 44 patients, three distinct fatigability trajectories and two mobility trajectories were identified over the course from hospital admission up to six months after discharge. Subsequently, three joint trajectories were identified, including low fatigability and high mobility (11%), improving fatigability and high mobility (52%), and high fatigability and low mobility (36%). Controlling for baseline functional status, patients with a lower comorbidity score (OR: 0.27, 95%CI 0.10; 0.74) and higher frailty status (OR: 1.36, 95%CI: 1.07; 1.74) were more likely to be a member of the high fatigability and low mobility trajectories.ConclusionsFrom hospital admission up to six months after discharge, three distinct trajectories of fatigability and mobility were identified among older medical patients. Our results should be interpreted with caution due to the small sample size, but may inspire other researchers to determine the value of fatigability assessment in identifying older medical patients at risk for developing mobility problems.
Highlights
Fatigability is an important marker of functional decline in community dwelling older people, yet its relationship with functional decline after hospitalization is unclear
Loss of mobility and exhaustion or fatigue are considered as early manifestations of frailty, contributing to functional decline and dependence in older people [15, 16]
The median comorbidity index score of the total group was 2 (IQR: 1; 3) and a detailed description comorbidity distribution is provided in Supplementary Table S3
Summary
Fatigability is an important marker of functional decline in community dwelling older people, yet its relationship with functional decline after hospitalization is unclear. Many older people still experienced fatigue, often leading to disruption of activities of daily living (ADL) [3]. Fatigability has emerged as an important marker of functional decline in community dwelling older people without disabilities [5,6,7], yet its relationship with functional decline after hospitalization is unclear. Functional decline is a serious consequence of hospitalization among older patients, with a prevalence rate of around 30% at the moment of discharge [8]. The association between mobility and fatigability among hospitalized older patients has not been directly investigated yet, but it may provide interesting information to design targeting interventions to prevent adverse outcomes after hospitalization of older patients
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