• Erja Portegijs, Bianca M Buurman, Marie-Louise Essink-Bot, Aeilko H Zwinderman, and Sophia E de Rooij.
• Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. E.Portegijs@amc.uva.nl
• J Am Med Dir Assoc. 2012 Jul 1;13(6):569.e1-7.

ObjectivesTo study the effects of functional decline on admission to long-term institutionalized care within 12 months from acute hospital admission.DesignPooled analyses of 3 longitudinal cohorts.SettingTertiary and secondary hospital.ParticipantsA total of 1085 community-dwelling patients older than 65 years acutely admitted to an internal medicine or orthopedic ward.MeasurementsDemographic data and medical data were collected within 2 days from hospital admission. Functional status (activities of daily living [ADL]) was assessed at baseline (reflecting preadmission status 2 weeks before admission) and 3 months after admission, and function loss (change between preadmission and 3 months) was calculated. Living situation was assessed 3 and 12 months after hospitalization. Cox regression analysis was used to predict institutionalization (living in a long-term assisted care or nursing home facility) within 12 months.ResultsADL function loss in the 3 months following hospital admission increased the risk of institutionalization also in patients without preadmission impairment (loss of function in 1 item HR = 5.3, 95% CI 2.2-12.6, p < .001; ≥2 items HR = 7.3, 95% CI 3.4-15.7, p < .001) compared with patients without impairment and function loss. The risk progressively increased with higher preadmission impairment. Patients with preadmission ADL impairment in 2 or more items without additional loss of function had an increased risk (HR = 6.4, 95% CI 3.1-13.3, p < .001) for institutionalization. This model was adjusted for age, gender, cognitive impairment, social situation, use of health care services, length of hospital stay, and comorbidity.ConclusionLoss of function in ADL tasks following hospitalization increased the risk for institutionalization, irrespective of preadmission ADL impairment. Potentially, counteracting loss of function in ADLs after acute hospital admission by more intensive rehabilitation may partly reduce the need for institutionalization.Copyright © 2012 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.

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