Gatenio-Hefling Orly, Tzemah-Shahar Roy, Asraf Kfir, Dilian Omer, Gil Efrat, Agmon Maayan
Faculty of Health and Social Welfare, University of Haifa, Haifa, Israel.
Max Stern Yezreel Valley College, Emek Yezreel, Israel.
Geroscience. 2025 Feb;47(1):1039-1048. doi: 10.1007/s11357-024-01280-3. Epub 2024 Jul 16.
Early detection of functional decline, a major risk among hospitalized older adults, can facilitate interventions that could significantly reduce it. We aimed to examine the contribution of the Timed Up and Go (TUG) test in predicting Hospitalization Associated Functional Decline (HAFD) among older adults, able to independently ambulate before admission. We used a cross-sectional study design; a total of 310 older adults (age ≥ 65) hospitalized in internal medicine wards between December 2018 and August 2020 were included; exclusion criteria were inability to ambulate, a diagnosis restricting mobility, hospitalization for end-of-life care, or impaired cognition. The Modified Barthel Index was used to assess HAFD; it was administered at admission to evaluate patients' independence in activities of daily living 2 weeks prior hospitalization, and at discharge. The TUG test was performed on admission and to predict significant functional decline (defined by a reduction of three points or more in the Modified Barthel Index), while accounting for demographics, length of hospitalization, comorbidity burden (Charlson's comorbidity index), and cognitive function (ALFI-MMSE). Participants were divided into three groups according to their TUG score-under or over a cut-off score of 12 s, or inability to complete the test. Adjusting for age, comorbidity, cognitive ability, and duration of hospitalization, the group that performed the test in less than 12 s showed no statistically significant change in the Modified Barthel Index, therefore no significant HAFD. The other groups showed a statistically significant decline in function. Risk for significant HAFD is currently underestimated in clinical settings, limited to subjective assessment, and underused in the context of implementing early interventions to prevent HAFD. The TUG may support screening for those at risk of hospitalizing-associated functional decline and could help identify patients suitable for preventative interventions.
功能衰退是住院老年人的一项主要风险，早期发现功能衰退有助于采取干预措施，从而显著降低功能衰退的程度。我们旨在研究定时起立行走（TUG）测试对预测入院前能够独立行走的老年人住院相关功能衰退（HAFD）的作用。我们采用了横断面研究设计；纳入了2018年12月至2020年8月期间在内科病房住院的310名老年人（年龄≥65岁）；排除标准为无法行走、诊断限制行动能力、临终关怀住院或认知障碍。采用改良巴氏指数评估HAFD；在入院时进行评估，以评估患者在住院前2周日常生活活动中的独立性，并在出院时再次评估。在入院时进行TUG测试，以预测显著的功能衰退（定义为改良巴氏指数降低三分或更多），同时考虑人口统计学因素、住院时间、合并症负担（查尔森合并症指数）和认知功能（ALFI-MMSE）。参与者根据其TUG得分分为三组——低于或高于12秒的临界值，或无法完成测试。在调整年龄、合并症、认知能力和住院时间后，TUG测试用时少于12秒的组在改良巴氏指数上没有统计学上的显著变化，因此没有显著的HAFD。其他组则显示出功能上有统计学意义的下降。目前，临床环境中对显著HAFD风险的评估不足，仅限于主观评估，并且在实施预防HAFD的早期干预措施时未得到充分利用。TUG测试可能有助于筛查有住院相关功能衰退风险的人群，并有助于识别适合预防性干预的患者。
