Lower limb function as predictor of falls and loss of mobility with social repercussions one year after discharge among elderly inpatients

Abstract

Poor mobility of the lower limbs in community-dwelling elderly people is a predictor of functional decline in terms of disability, falls, nursing home admission, and death. However, its predictive value has not been studied in acute care hospital settings. The aims of this observational, prospective study were: 1) to assess the prognostic value of lower limb function; and 2) to compare the predictive value of three performance tests in elderly inpatients. We studied 144 patients aged 70 or older (60 men and 84 women, mean age 78.7 +/- 5.6 years), admitted consecutively to a general internal medicine ward. Before discharge, patients underwent multidimensional assessment, including static and dynamic equilibrium and gait, by the Performance-Oriented Mobility Assessment (POMA), Short Physical Performance Battery (SPPB), and Functional Reach (FR). One-year outcomes were falls, loss of mobility with social repercussions (inability to leave home, or need for nursing home care) and death. In univariate analysis, poor results on any of the three tests were associated with an increased risk of falls, loss of mobility with social repercussions, and death. In multivariate analysis, age, two or more falls, and a low POMA score were predictive of future falls, whereas dependency in instrumental activities of daily living and a low SPPB score were predictive of loss of mobility with social repercussions. No multivariate model was superior to univariate ones in predicting death. No associations were found between other medical or geriatric characteristics and outcomes. Lower limb mobility tests performed in an acute care hospital setting are predictive of future falls, inability to leave home, and/or need for nursing home care.