• Ruth E Hubbard, Eamonn M P Eeles, Michael R H Rockwood, Nader Fallah, Elyse Ross, Arnold Mitnitski, and Kenneth Rockwood.
• Geriatric Medicine Research Unit, Dalhousie University & Capital District Health Authority, Halifax, NS, Canada.
• J Gen Intern Med. 2011 Dec 1; 26 (12): 147114781471-8.

BackgroundArchetypal symptoms and signs are commonly absent in frail older people who are acutely unwell. This challenges both recognition of illness and monitoring of disease progression in people at high risk of prolonged hospital stays, institutionalization and death.ObjectiveTo determine whether bedside assessment of balance and mobility could track acute changes in the health status of older people admitted to hospital.DesignProspective cohort study.ParticipantsFour hundred nine patients, with a mean age of 81.8 years, admitted to general medical and rehabilitation wards at a tertiary care teaching hospital in Halifax, Nova Scotia. No patient refused assessment, and the only exclusion criterion was age.InterventionsThe Hierarchical Assessment of Balance and Mobility (HABAM) was completed daily during the first 2 weeks of admission. For each patient, frailty status was measured on admission by a Frailty Index based on a Comprehensive Geriatric Assessment (FI-CGA).Main MeasuresDeath and discharge destination.Key ResultsPoor performance in balance, transfers and mobility was associated with adverse outcomes. Forty-eight percent of patients with the lowest scores in all three domains died, compared with none with the highest scores. The relative risk of death for people who deteriorated during the first 48 h of admission was 17.1 (95% confidence interval: 4.9-60.3). Changes in HABAM scores were related to the discharge destination: patients discharged home showed the greatest rate of improvement, whereas those discharged to institutions stabilised at a lower level of performance. Fitter patients tended to have better performance on admission and faster recovery.ConclusionsDaily bedside observation of mobility and balance allows assessment of acute changes in the health of older people. Frailty slows recovery of mobility and balance, and reduces recovery potential. By identifying patients most vulnerable to adverse outcomes, the HABAM and FI-CGA may facilitate risk stratification in older people admitted to hospital.

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