Kolk Daisy, Melis René J F, MacNeil-Vroomen Janet L, Buurman Bianca M
Amsterdam UMC, University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam, Netherlands.
Department of Geriatric Medicine/Radboud Alzheimer Centre, Radboud University Medical Centre, Nijmegen, Netherlands.
J Am Med Dir Assoc. 2022 May;23(5):903.e1-903.e12. doi: 10.1016/j.jamda.2021.08.029. Epub 2021 Sep 17.
Insight into older adults' physical resilience is needed to predict functional recovery after hospitalization. We assessed functional trajectories in response to acute illness and subsequent hospitalization and investigated baseline variables and dynamic variables associated with these trajectories.
Prospective observational cohort study (Hospitalization-Associated Disability and impact on daily Life Study).
This study included 207 older adults (aged 79.8 ± 6.9 years, 49% female, 57% frail) acutely hospitalized in 6 Dutch hospitals.
Functional disability was assessed using the 15-item modified activities of daily living index retrospectively 2 weeks before admission, and prospectively from admission up to 3 months after discharge. Baseline variables including frailty, somatic, physical, and psychosocial factors were assessed at admission. Dynamic variables (step count, pain, fatigue, and fear of falling) were continuously or repeatedly assessed during hospitalization. We performed individual spline modeling using random effects. Baseline variables and within-person mean levels and variability in the dynamic variables were assessed as predictors of functional trajectories.
Functional disability significantly increased before admission and decreased from admission to 3 months post discharge. Frail participants had a significantly higher increase in functional disability before admission compared with nonfrail participants. Lower step count, higher pain scores, and higher within-person variability in fear of falling were significantly associated with higher increase in functional disability before admission. Higher within-person variability in fear of falling was associated with more recovery.
Older adults increase in functional disability before hospitalization and start to recover from admission onward. Frailty and dynamic variables are associated with a higher increase in functional disability after acute illness. Our findings give more insight into older adults' physical resilience, which may improve the prediction of functional recovery and may improve therapeutic decision-making and rehabilitation strategies to improve functional recovery after acute hospitalization.
为预测住院后的功能恢复情况，需要深入了解老年人的身体恢复力。我们评估了急性疾病及随后住院后的功能轨迹，并调查了与这些轨迹相关的基线变量和动态变量。
前瞻性观察队列研究（住院相关残疾及其对日常生活的影响研究）。
本研究纳入了在6家荷兰医院急性住院的207名老年人（年龄79.8±6.9岁，49%为女性，57%为体弱老人）。
在入院前2周回顾性地使用15项改良日常生活活动指数评估功能残疾情况，并在入院后直至出院后3个月前瞻性地进行评估。在入院时评估包括体弱、躯体、身体和心理社会因素在内的基线变量。在住院期间持续或反复评估动态变量（步数、疼痛、疲劳和跌倒恐惧）。我们使用随机效应进行个体样条建模。将基线变量以及动态变量的个体内平均水平和变异性作为功能轨迹的预测因素进行评估。
功能残疾在入院前显著增加，从入院到出院后3个月有所下降。与非体弱参与者相比，体弱参与者在入院前功能残疾的增加显著更高。步数较低、疼痛评分较高以及跌倒恐惧的个体内变异性较高与入院前功能残疾的增加显著相关。跌倒恐惧的个体内变异性较高与更多的恢复相关。
老年人在住院前功能残疾增加，入院后开始恢复。体弱和动态变量与急性疾病后功能残疾的更高增加相关。我们的研究结果更深入地了解了老年人的身体恢复力，这可能会改善对功能恢复的预测，并可能改善治疗决策和康复策略，以促进急性住院后的功能恢复。
