• J Gen Intern Med · May 2007

    Comparative Study

    Characteristics of nondisabled older patients developing new disability associated with medical illnesses and hospitalization.

    • Stefano Volpato, Graziano Onder, Margherita Cavalieri, Gianluca Guerra, Fotini Sioulis, Cinzia Maraldi, Giovanni Zuliani, Renato Fellin, and Italian Group of Pharmacoepidemiology in the Elderly Study (GIFA).
    • Department of Clinical and Experimental Medicine, Section of Internal Medicine, Gerontology, and Geriatrics, University of Ferrara, Ferrara, Italy. vlt@unife.it
    • J Gen Intern Med. 2007 May 1; 22 (5): 668674668-74.

    ObjectiveTo identify demographic, clinical, and biological characteristics of older nondisabled patients who develop new disability in basic activities of daily living (BADL) during medical illnesses requiring hospitalization.DesignLongitudinal observational study.SettingGeriatric and Internal Medicine acute care units.ParticipantsData are from 1,686 patients aged 65 and older who independent in BADL 2 weeks before hospital admission, enrolled in the 1998 survey of the Italian Group of Pharmacoepidemiology in the Elderly Study.MeasurementsStudy outcome was new BADL disability at time of hospital discharge. Sociodemographic, functional status, and clinical characteristics were collected at hospital admission; acute and chronic conditions were classified according to the International Classification of Disease, ninth revision; fasting blood samples were obtained and processed with standard methods.ResultsAt the time of hospital discharge 113 patients (6.7%) presented new BADL disability. Functional decline was strongly related to patients' age and preadmission instrumental activities of daily living status. In a multivariate analysis, older age, nursing home residency, low body mass index, elevated erythrocyte sedimentation rate, acute stroke, high level of comorbidity expressed as Cumulative Illness Rating Scale score, polypharmacotherapy, cognitive decline, and history of fall in the previous year were independent and significant predictors of BADL disability.ConclusionSeveral factors might contribute to loss of physical independence in hospitalized older persons. Preexisting conditions associated with the frailty syndrome, including physical and cognitive function, comorbidity, body composition, and inflammatory markers, characterize patients at high risk of functional decline.

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