Abstract
ObjectiveMobility limitations relate to dependency in older adults. Identification of older patients with mobility limitations after hospital discharge may help stratify treatment and could potentially counteract dependency seen in older adults after hospitalization. We investigated the ability of four physical performance measures administered at hospital admission to identify older medical patients who manifest mobility limitations 30 days after discharge.DesignProspective cohort study of patients (≥65 years) admitted to the emergency department for acute medical illness. During the first 24 hours, we assessed: handgrip strength, 4-meter gait speed, the ability to rise from a chair (chair-stand), and the Cumulated Ambulation Score. The mobility level 30 days after discharge was evaluated using the de Morton Mobility Index.ResultsA total of 369 patients (77.9 years, 62% women) were included. Of those, 128 (40%) patients had mobility limitations at follow-up. Univariate analyzes showed that each of the physical performance measures was strongly associated with mobility limitations at follow-up (handgrip strength(women), OR 0.86 (0.81–0.91), handgrip strength(men), OR 0.90 (0.86–0.95), gait speed, OR 0.35 (0.26–0.46), chair-stand, OR 0.04 (0.02–0.08) and Cumulated Ambulation Score OR 0.49 (0.38–0.64). Adjustment for potential confounders did not change the results and the associations were not modified by any of the covariates: age, gender, cognitive status, the severity of the acute medical illness, and the Charlson Comorbidity Index. Based on prespecified cut-offs the prognostic accuracy of the four measures for mobility limitation at follow-up was calculated. The sensitivity and specificity were: handgrip strength(women), 56.8 (45.8–67.3), 75.7 (66.8–83.2), handgrip strength(men), 50.0 (33.8–66.2), 80.8 (69.9–89.1), gait speed, 68.4 (58.2–77.4), 81.4 (75.0–86.8), chair-stand 67.8 (58.6–76.1), 91.8 (86.8–95.3), and Cumulated Ambulation Score, 40.2 (31.6–49.2), 92.0 (87.1–95.4), respectively.ConclusionPhysical performance measures, particularly chair-stand and gait speed assessed at admission to an emergency department, were able to identify mobility limitation in acutely admitted older medical patients 30 days after hospital discharge.
Highlights
Functional status— mobility—is an important manifestation of illness in older adults, and a relevant prognostic factor of adverse health events in geriatric treatment across diagnoses [1,2,3,4]
Univariate analyzes showed that each of the physical performance measures was strongly associated with mobility limitations at follow
Chair-stand and gait speed assessed at admission to an emergency department, were able to identify mobility limitation in acutely admitted older medical patients 30 days after hospital discharge
Summary
Functional status— mobility—is an important manifestation of illness in older adults, and a relevant prognostic factor of adverse health events in geriatric treatment across diagnoses [1,2,3,4]. Mobility limitations following medical hospitalization are often sustained [20], and studies found that only 30% of patients with functional decline during medical hospitalization regained their loss within one year after discharge [21,22] These findings indicate that the recovery of functional loss is compromised in many older medical patients, which results in a persistent lower functional level than before the hospitalization [20,22,23], often initiating a vicious circle with restricted social activities, reduced physical activity, and further dependence [1,20]. Functional decline could potentially be reduced if relevant interventions were offered to medical patients with a high risk of persistent mobility limitations after hospitalization. This requires early identification of at-risk patients
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