Hospitalized older adult: predictors of functional decline

Tavares, João Paulo de Almeida; Nunes, Lisa Alexandra Nogueira Veiga; Grácio, Joana Catarina Gonçalves

doi:10.1590/1518-8345.3612.3399

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Original Article • Rev. Latino-Am. Enfermagem 29 • 2021 • https://doi.org/10.1590/1518-8345.3612.3399 linkcopy

Hospitalized older adult: predictors of functional decline^*

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective: to identify the predictors of functional decline in hospitalized individuals aged 70 or over, between: baseline and discharge; discharge and follow-up, and baseline and three-month follow-up.

Method: a prospective cohort study conducted in internal medicine services. A questionnaire was applied (clinical and demographic variables, and predictors of functional decline) at three moments. The predictors were determined using the binary logistic regression model.

Results: the sample included 101 patients, 53.3% female, mean age of 82.47 ± 6.57 years old. The predictors that most contributed to decline in hospitalization were the following: previous hospitalization (OR=1.8), access to social support (OR=4.86), cognitive deficit (OR=6.35), mechanical restraint (OR=7.82), and not having a partner (OR=4.34). Age (OR=1.18) and medical diagnosis (OR=0.10) were the predictors between discharge and follow-up. Being older, delirium during hospitalization (OR=5.92), and presenting risk of functional decline (OR=5.53) were predictors of decline between the baseline and follow-up.

Conclusion: the most relevant predictors were age, previous hospitalization, cognitive deficit, restraint, social support, not having a partner, and delirium. Carrying out interventions aimed at minimizing the impact of these predictors can be an important contribution in the prevention of functional decline.

Descriptors:
Aged; Health of the Elderly; Nursing; Hospitalization; Logistic Models; Functional Decline

Variable	Instrument	Collection moment
Age, gender, level of schooling, marital status, family nucleus	Sociodemographic questionnaire	Admission
Admission date, admission diagnosis(es), multimorbidity, number of previous hospitalizations, hospitalization period, number and type of medications, and therapeutical attitudes	Clinical questionnaire and Charlson Comorbidity Index	Admission
Cognitive decline	Cognitive Decrease Test (6CIT)⁽²³⁾	Admission
Senses (sight and hearing)	Question "can you see well?"; "can you hear well?"	Admission
Affective state	Single item of the Geriatric Depression Scale⁽²⁴⁾	During hospitalization (3 to 5 days after admission)
Fear of falling	Single item of fear of falling⁽²⁵⁾	During hospitalization
Falls	Record of falls during hospitalization	Discharge
Pain	Numerical Scale or Qualitative Scale	During hospitalization
Delirium	Confusion Assessment Method⁽²⁶⁾	Admission and during hospitalization
Restraint	Observation grid of physical restriction⁽²⁷⁾	During hospitalization
Risk of functional decline	ISAR-HP - Portuguese version⁽²⁸⁾	Admission
Functional capacity of the OA	Katz Index⁽²⁹⁾	Admission, discharge and follow-up

Clinical characteristics	Patients without decline (n = 74)	Patients with decline (n = 27)	p/OR*	Log† regression
Clinical characteristics	Patients without decline (n = 74)	Patients with decline (n = 27)	p/OR*	p/OR
Age (M‡±SD§)	81.0 (6.08)	83.69 (6.77)	0.04**	0.76/0.98
Male (%)	20 (42.6)	27 (57.4)	0.03††/2.5	0.71/1.32
Without a partner (%)	37 (68.5)	17 (37)	0.01††/3.7	0.02/4.34
With social support (t0) (%)	5 (12.5)	14 (31.8)	0.04††/0.31	0.04/4.86
Hospitalizations in the last year (Median, 1^st and 3^rd)	0 (0 - 0)	0 (0 - 1)	<0.01^¤	0.03/1.80
Psychoactive drugs	20 (43.5)	34 (61.8)	0.07††	0.13/2.77
Does not see well (%)	21 (45.7)	35 (63.6)	0.07††	0.32/0.51
Does not hear well (%)	13 (28.3)	23 (41.8)	0.16††	0.50/0.56
Fear of falling (%)	20 (47.6)	35 (67.3)	0.05††	0.78/1.27
High risk of falls (%)	20 (44.4)	28 (50.9)	0.01††	0.23/4.34
High risk of PI\|\|(%)	8 (18.2)	24 (43.6)	<0.01††/3.5	0.46/1.84
Cognitive decline (%)	12 (26.1)	30 (55.6)	<0.01††/3.5	<0.01/6.35
Depression	25 (55.6)	43 (78.6)	0.02††	0.97/0.96
Delirium at admission (%)	-	9 (16.4)	<0.01††/2	-
Delirium during hospitalization (%)	2 (4.8)	8 (15.1)	0.18††	0.46/2.84
Restraint (%)	6 (14.3)	27 (51.9)	<0.01††/6.5	<0.01/7.82
CCF¶(Me, 1^st and 3^rd Q)	0.5 (0.22 - 0.56)	0.47 (0.36 - 0.63)	0.30‡‡	0.69/1.91
Risk of functional decline (%)	30 (65.2)	47 (85.5)	0.02††/3.1	0.84/1.22

Clinical characteristics	Patients without decline (n = 74)	Patients with decline (n = 27)	p/OR*	Log† regression
Clinical characteristics	Patients without decline (n = 74)	Patients with decline (n = 27)	p/OR*	p/OR
Age (Median, 1^st and 3^rd Q)	81 (76 - 87)	86 (83 - 89)	<0.01§	<0.01/1.18
Admission diagnosis (%) Infectious disease	39 (38.6)	4 (4)	<0.01\|\|	<0.01/0.10
Number of medications (Median, 1^st and 3^rd Q)	6.5 (3.75 - 10)	8 (6 - 11)	0.11§	0.48/1.05
Hospitalizations in the last year (Median, 1^st and 3^rd Q)	0 (0 - 1)	1 (0 - 1)	0.03§	0.077/0.92
CCI‡ (Median, 1^st and 3^rd Q)	4 (4 - 7)	6 (5 - 8)	0.01§	0.21/1.2
Does not hear well (%)	23 (31.1)	13 (48.1)	0.11¶	0.92/1.08
Weight loss (%)	49 (66.2)	23 (85.2)	0.06¶	0.39/1.84
Delirium during hospitalization (%)	5 (7.2)	5 (19.2)	0.13\|\|	0.16/3.62
Cognitive decline (%)	28 (37.8)	14 (53.8)	0.15¶	0.44/1.593
Risk of functional decline (%)	51 (68.9)	26 (96.3)	<0.01¶/11.7	0.14/5.29

Clinical characteristics	Patients without decline (n = 74)	Patients with decline (n = 27)	p/OR*	Log† regression
Clinical characteristics	Patients without decline (n = 74)	Patients with decline (n = 27)	p/OR*	p/OR
Age (M‡±SD§)	80.34 (6.22)	85.77 (5.77)	0.00**	0.04/1.10
With social support (t0) (%)	9 (17.3)	10 (31.3)	0.14††	0.43/1.65
Hospitalizations in the last year (%)	0 (0 - 1)	0 (0 - 1)	0.09‡‡	0.99/0.99
CCI\|\| (Me, 1^st and 3^rd Q)	5 (4 - 7)	6 (4 - 7)	0.04‡‡	0.29/1.14
ERRD¶ (Me, 1^st and 3^rd Q)	6.38 (4.4 - 13.37)	9.23 (6.38 - 13.37)	0.05‡‡	0.87/1.02
Does not hear well (%)	18 (29.5)	18 (45.0)	0.11††	0.74/0.83
Cognitive decline (%)	21(34.5)	21 (53.8)	0.06††	0.62/1.35
Depression	35 (58)	33 (82.5)	0.02††/0.3	0.14/2.35
Delirium during hospitalization (%)	2 (3.6)	8 (20.5)	0.01§§	0.06/5.9
Restraint (%)	15 (26.8)	18 (47.4)	0.13††	0.88/1.02
Length of hospitalization (Median, 1^st and 3^rd Q)	7 (5 - 10)	9 (6 - 17.5)	0.05‡‡	0.97/0.99
Risk of functional decline (%)	39 (63.9)	38 (95.0)	<0.01††/10.72	0.04/5.53

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[TFN1] ^*
OR = Odds Ratio;

[TFN2] ^†
Log = Logistic;

[TFN3] ^‡
M = Mean;

[TFN4] ^§
SD = Standard deviation;

[TFN5] ^||
PI = Pressure injur;

[TFN6] ^¶
CCF = Care Centered on Functionality;

[TFN7] ^**
Student's t test;

[TFN8] ^††
Chi-square test;

[TFN9] ^‡‡
Mann-Whitney's U test

Hospitalized older adult: predictors of functional decline*

Abstract

Hospitalized older adult: predictors of functional decline^*