Recovery of Functional Impairment after Acute Illness and Mortality: One-Year Follow-Up Study

Abstract

Background: Functional status in older people is a dynamic situation, which makes it necessary to evaluate functional capacity at different times to determinate their prognostic value. Objective: To examine the association between functional status (baseline and change after acute illness) and mortality and functional changes at 1 year. Methods: Hospital-based prospective longitudinal cohort study of all patients over 65 years old, admitted for multidisciplinary treatment of functional impairment after acute illness in a medium-stay unit (post-acute geriatric unit) of a teaching hospital ascribed to the Spanish National Health Service from Spain during 15 consecutive months. Functional status (Barthel Index, BI) was assessed prior to the acute illness, at admission in a post-acute unit, at discharge and 1 year later. At admission, other variables were collected: sociodemographic, main diagnostic for hospitalization (stroke, orthopedic process, or deconditioning), serum albumin, comorbidity (Charlson Index), cognitive status (Pfeiffer´s Short Portable Mental Status Questionnaire). In order to analyze mortality 1 year after discharge, a Cox regression analysis was performed. Results: Three hundred and sixty-nine patients consituted the study population, mean age was 80.74 years (SD 7.4), 66.6% were female and 1 year after discharge mortality was 20%. In the multivariate analysis, variables associated with a higher 1-year mortality were age (HR 1.06; 95% CI = 1.00–1.07) male gender (HR 2.11; 95% CI = 1.26–3.55), worse prior functional status (HR 0.98; 95% CI = 0.96–0.99), and higher functional loss in BI at admission (HR 1.02; 95% CI = 1.00–1.04). On the other hand, a greater functional gain in BI at discharge was associated with a lower 1-year mortality (HR 0.98; 95% CI = 0.96–0.99). Conclusions: The main functional gain obtained after treatment in a multidisciplinary post-acute geriatric unit is independently associated with a reduction in long-term mortality. In addition to baseline functional status and after acute illness, the subsequent potential recovery is very important to predict poor long-term outcomes.